WAL-MART STORES TEXAS LLC

NPI: 1003226093 · EL PASO, TX 79932 · Community/Retail Pharmacy · NPI assigned 04/30/2014

Billing Flags · Automated signals — not evidence of fraud

Entity Proliferation

Authorized official CANONIC, KIMBERLY controls 20+ related entities in our dataset. Read more

$230.87

Total Medicaid Paid

112

Total Claims

112

Beneficiaries

Codes Billed

2019-07

First Month

2019-08

Last Month

Provider Details

Authorized Official	CANONIC, KIMBERLY (SENIOR DIRECTOR, ENROLLMENT)
NPI Enumeration Date	04/30/2014

Other providers sharing the same authorized official: CANONIC, KIMBERLY

Provider	City	State	Total Paid
WALMART INC.	INDEPENDENCE	IA	$7K
WALMART INC.	ANKENY	IA	$3K
WALMART INC.	WINDSOR HEIGHTS	IA	$2K
WALMART INC.	IOWA CITY	IA	$2K
WALMART INC.	CENTERVILLE	IA	$2K
WALMART INC.	DENISON	IA	$2K
WALMART INC.	WEST BURLINGTON	IA	$1K
WALMART INC.	MONTICELLO	AR	$1K
WALMART INC.	MASON CITY	IA	$919.50
WAL-MART STORES EAST LP	KENDALL	FL	$301.97
WALMART INC.	WASECA	MN	$242.86
WAL-MART STORES EAST LP	HIALEAH	FL	$160.00
WALMART INC.	BROOKLYN PARK	MN	$81.46
WAL-MART STORES EAST LP	EVANSVILLE	IN	$74.87
WALMART INC.	PINE CITY	MN	$63.44
WALMART INC.	ANAMOSA	IA	$41.46
WAL-MART STORES EAST LP	JACKSONVILLE	FL	$28.39
WALMART INC.	SHENANDOAH	IA	$22.95
WAL-MART STORES EAST LP	OCALA	FL	$1.12
WALMART INC.	FAYETTEVILLE	AR	$0.07

Year	Claims	Total Paid
2019	112	$230.87

Code	Description	Claims	Beneficiaries	Total Paid
A4253	Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips	50	50	$223.94
A4259	Lancets, per box of 100	16	16	$6.93
V2100	Sphere, single vision, plano to plus or minus 4.00, per lens	14	14	$0.00
V2020	Frames, purchases	16	16	$0.00
92340	Fitting of spectacles, except for aphakia; monofocal	16	16	$0.00