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Date: 2021-02-02 17:23:11.137640
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Date: 2021-02-03 13:47:58.761950
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Date: 2021-07-14 13:37:10.675031
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Requested from IC by J. Perez at 05:23 PM on
Feb 02, 2021.
Purpose: Reimbursement/Claim/Payment
Date of Coverage: 09/12/2018 - 02/02/2021
Tracking no: #IC-829401463284
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