503 B
503 B
| 1 | account_number | item_description | order_date | units_dispensed | plan_name | component | Facility |
|---|---|---|---|---|---|---|---|
| 2 | PT-1141 | Dexcom G7 CGM | 01/05/2026 | 9 | Aetna | sensor | Gaboro PA Main |
| 3 | PT-1142 | dexcom g7 | 30/04/2026 | 2 | Aetna | sensor | Gaboro PA Main |
| 4 | PT-1143 | Dexcom G7 CGM | 27/04/2026 | 1 | Aetna | sensor | Gaboro PA Main |
| 5 | PT-1144 | G7 | 28/04/2026 | 1 | Aetna | sensor | Gaboro PA Main |
| 6 | PT-1145 | dexcom g7 | 03/05/2026 | 9 | Aetna | sensor | Gaboro PA Main |
| 7 | PT-1146 | G7 | 01/05/2026 | 2 | Aetna | sensor | Gaboro PA Main |
| 8 | PT-1147 | Dexcom G7 | 29/04/2026 | 2 | Aetna | sensor | Gaboro PA Main |