🔗 Linked Evidence
PBC_MEDS — p.2
📄 PBC MEDS | p.2
📄 PBC MEDS | p.2
📝 Extracted Text (OCR)
6/14/26, 1:02 AM Service Date V Mar 05, 2026 Mar 05, 2026 Mar 05, 2026 Mar 05, 2026 Mar 05, 2026 Mar 04, 2026 Mar 04, 2026 Mar 04, 2026 Mar 04, 2026 Mar 04, 2026 Feb 25, 2026 Feb 25, 2026 Feb 25, 2026 Feb 25, 2026 Feb 05, 2026 Jan 31, 2026 Jan 31, 2026 Jan 31, 2026 Jan 31, 2026 Jan 31, 2026 Jan 30, 2026 Jan 30, 2026 Jan 30, 2026 Jan 14, 2026 Dec 22, 2025 Nov 14, 2025 Nov 14, 2025 Oct 06, 2025 Aug 19, 2025 Aug 18, 2025 Name Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Mark Holand Expense/Item PMS TRAZODONE HCL TAB 100MG PMS-RISPERIDONE APO-TRAZODONE TABLETS 100MG RISPERIDONE SERTRALINE QUETIAPINE QUETIAPINE Nicorette Gum 2 mg Nicorette Gum 2 mg Nicorette Gum 2 mg SUMATRIPTAN SUMATRIPTAN APO-BILASTINE TABLETS SUMATRIPTAN DF QUETIAPINE NURTEC ODT PANTOPRAZOLE APO PREDNISONE TAB 5OMG SUMATRIPTAN DF SUMATRIPTAN DF APO-BILASTINE TABLETS AIMOVIG NURTEC ODT Nicorette Gum 2 mg APO-BILASTINE TABLETS TEVA-SUMATRIPTAN DF APO-BILASTINE TABLETS APO-BILASTINE TABLETS TEVA-SUMATRIPTAN DF APO-BILASTINE TABLETS Page 1 Total Grand Total « First | « Previous | Page 1 of2 | Next» | Last » *@Patific Blue Cross is the registered tradename of PBC Health Benefits Society (PBC), an independent licensee of the Canadian Association of Blue Cross Plans (CABCP). Pacific Blue Cross and the cross design are trademarks of the CABCP. Blue Shield is a registered trademark of Blue Cross Blue Shield Association. Insurance is sold through PacBlue Life Services Ltd., dba Pacific Blue Cross Agency, a licensed insurance agency and wholly owned subsidiary of PBC. Insurance is underwritten by various underwriters. For information on underwriters visit pac.bluecross.ca/Disclosure. All rights reserved. Privacy Statement Legal Complaints Security Browser Requirements Browser Capabilities Pacific Blue Cross Amount Claimed 17.02 19.45 17.02 19.45, 24.37 19.13 19.13 95.24 95.24 95.24 35.25 71.17 55.38 49.46 17.25 $219.39 19.41 15.71 49.46 $110.84 55.38 $632.40 $219.39 95.24 54.23 45.03 54.23 54.23 $104.05 55.40 $3,036.01 $4,311.41 https://service.pac.bluecross.ca/ACESWeb/Pages/Claims/Claims.aspx? MODULE=ALL Amount Paid $12.69 $14.47 0.00 0.00 $18.77 $13.71 0.00 0.00 0.00 0.00 35.25 0.00 52.14 0.00 12.81 0.00 14.44 12.06 44.83 $0.00 27.14 $0.00 $0.00 $0.00 $51.14 $40.71 $51.14 $51.14 $102.13 $51.14 $1,114.48 $2,004.16 Statement Date Mar 05, 2026 Mar 05, 2026 Mar 05, 2026 Mar 05, 2026 Mar 05, 2026 Mar 04, 2026 Mar 04, 2026 Mar 04, 2026 Mar 04, 2026 Mar 04, 2026 Feb 25, 2026 Feb 25, 2026 Feb 25, 2026 Feb 25, 2026 Feb 05, 2026 Jan 31, 2026 Jan 31, 2026 Jan 31, 2026 Jan 31, 2026 Jan 31, 2026 Jan 30, 2026 Jan 30, 2026 Jan 30, 2026 Jan 14, 2026 Dec 22, 2025 Nov 14, 2025 Nov 14, 2025 Oct 06, 2025 ‘Aug 19, 2025 ‘Aug 18, 2025 Contact CUPE 1816 | 7.7.594.4 - ACES. Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details Details 2/2