458 B
458 B
| 1 | MRN | Product Type | Service Date | Qty | Insurance Name | Component Type |
|---|---|---|---|---|---|---|
| 2 | PT-1151 | Libre 3 | 2025-06-24 | 1 | Humana | sensor |
| 3 | PT-1152 | FreeStyle Libre 3 | 2025-08-01 | 6 | Humana | sensor |
| 4 | PT-1153 | fs libre 3 | 2025-06-16 | 3 | Humana | sensor |
| 5 | PT-1154 | Libre 3 | 2025-07-13 | 2 | Humana | sensor |
| 6 | PT-1155 | Libre 3 | 2025-05-01 | 6 | Humana | sensor |
| 7 | PT-1156 | FreeStyle Libre 3 | 2025-07-15 | 3 | Humana | sensor |
| 8 | PT-1157 | FreestyleLibre3 | 2025-07-23 | 6 | Humana | sensor |
| 9 | PT-1158 | FreeStyle Libre 3 | 2025-09-06 | 1 | Humana | sensor |