VIDRINE PHARMACEUTICAL GROUP, LLC
NPI: 1043838469
· LAKE CHARLES, LA 70601
· Compounding Pharmacy
· NPI assigned 07/13/2020
$15.92
Total Medicaid Paid
Provider Details
| Authorized Official | VIDRINE, JESSE (OWNER) |
| Parent Organization | VIDRINE PHARMACEUTICAL GROUP, LLC |
| NPI Enumeration Date | 07/13/2020 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
683 |
$15.92 |
| 2022 |
57 |
$0.00 |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 0001A |
|
113 |
103 |
$15.92 |
| 0013A |
|
164 |
164 |
$0.00 |
| 0002A |
|
76 |
74 |
$0.00 |
| 0003A |
|
91 |
91 |
$0.00 |
| 0012A |
|
133 |
129 |
$0.00 |
| 0011A |
|
151 |
143 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |