All Medicaid billing entities listing POTTENGER, CHARLES (AUTHORIZED OFFICIAL) as their authorized official in the NPPES registry.
| State | Entities | Total Paid |
|---|---|---|
| Idaho | 1 | $187.25 |
| # | Provider | Location | Specialty | Total Paid |
|---|---|---|---|---|
| 1 | CLEARWATER CANYON PHARMACY, LLC | OROFINO, ID | Community/Retail Pharmacy | $187.25 |