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Basic Restorative Services - Other Members

Member for

7 years 4 months

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

Service Benefit Category Id

11375

Diabetes management services

Member for

7 years 4 months

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

Service Benefit Category Id

11377

Necessary and appropriate orthodontic Services

Member for

7 years 4 months

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

Service Benefit Category Id

11380

Retail - Tier 4

Member for

7 years 4 months

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

Service Benefit Category Id

11384

Retail - Tier 5

Member for

7 years 4 months

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

Service Benefit Category Id

11385

Retail - Tier 6

Member for

7 years 4 months

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

Service Benefit Category Id

11386

Mail - Value Drugs Tier 4

Member for

7 years 4 months

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

Service Benefit Category Id

11390

Mail - Value Drugs Tier 6

Member for

7 years 4 months

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

Service Benefit Category Id

11392

Mail - Tier 1

Member for

7 years 4 months

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

Service Benefit Category Id

11393

Mail - Tier 2

Member for

7 years 4 months

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

Service Benefit Category Id

11394