6/14/26, 1.03 AM Pacific Blue Cross

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Individual Show Claims Within Service Date Range
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Service Date ¥ Nema Expense}item Amount Claimed Amount Pala Statement Date
Pay 18, 2925 Mark Holind TEVA-SUMATRIPTAN OF $233.28 $0.00 Aug 19, 2025 Detads
Bet a Fak Peter’ APO-SHASTINE TASLENS $85 46 SSt44 ka 13, 2025 Ceteis

Jan le, BBS Hage batend APC:SULASTINE TABLETS

AS $31.14 Jun 16, 275 Demis

Mars Heid TEVA SIMATRIPTAN GF 432225 May 27, 2025 Deads
‘Hack Hatara: PANTOPRATIME MAGES $36.14 SAF May Fh 2025 Delats.
Mork Hocand APO-SEASTING TARLETS, $5540 S5L.14 May 14, 2025 ‘Detals
Mara, NDE Mosk Malan ‘APO-BILASTINE TABLETS 45540 451.14 Mar 24, 2025 Detals
deb a8, 2023 Bik Hoan TEVASUMATHIPIAN UF SATS $3225 Fed 26, AS Detats
Feb 25, 2025 Mark Hoksind TEVA: SUMATRIPTAN DF SITE $0.00 Feb 26, 2025 Detais
Fem 17, ADE Mark Kidaoxs: APO SILASTINE TASLETS. $55.40 $5.14 Fed 12, 2025 Details
Jan 14, 2025 Mark Helarsd PLENTEN ‘$63.41 $5681 Jan 14, 2075 Details:
Jan 14, 2025 Mark Holand LEXTEN $6341 $0.20 Jan 14, 2028 Details
tow a Rank Hotarxt TEVA SUMATRIPIAN OF MKT $145) Now 22, 24 Botats
Ausy 06, 704 Mark Hobwst TEVA SUMATRISTAN DF S473 $144.33 Aug 06, AF Detats
Page 2 Tctal 31,275.40 $889.68
Grand Tatal $4311.41 $2,004.16

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e@ G— Pending: Dr. Abdalkhani, Pacific ENT, consultation of July 16, 2026 (addendum upon
receipt).

e —CHCPBC Case ID: 2026-037 — professional conduct complaint against Flora Pang,
correspondence with Investigatar Raul Franco, May !4—July 16, 2026.

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