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With Other PCP - Outpatient Services

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11363

Medicare-eligible preventive exams, immunizations and screening tests

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11364

Pediatric Essential Dental Plan - Preventive and Diagnostic

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11365

Pediatric Essential Dental Plan - Basic Restorative

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11366

Pediatric Essential Dental Plan - Major Restorative

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11367

Pediatric Essential Dental Plan - Orthodontics

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11368

Vision supplies for members age 12 or younger

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11369

Vision supplies for members age 13 or older

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11370

Harvard University Retail pharmacy (90-day supply)

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11442

Medicare Part D covered drugs - Mail service pharmacy

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:10

Service Benefit Category Id

11445