446 B
446 B
| 1 | External Patient Ref | Item Description | Dispense Date | Quantity | Plan Name | Supply Type |
|---|---|---|---|---|---|---|
| 2 | PT-1221 | OmniPod 5 | 04/30/2026 00:00:00 | 2 | Molina Healthcare | pod |
| 3 | PT-1222 | OmniPod 5 | 04/29/2026 00:00:00 | 9 | Molina Healthcare | pod |
| 4 | PT-1223 | Omnipod | 04/26/2026 00:00:00 | 2 | Molina Healthcare | pod |
| 5 | PT-1224 | Omnipod | 05/03/2026 00:00:00 | 2 | Molina Healthcare | pod |
| 6 | PT-1225 | op5 | 04/28/2026 00:00:00 | 3 | Molina Healthcare | pod |
| 7 | PT-1226 | op5 | 05/02/2026 00:00:00 | 1 | Molina Healthcare | pod |