WAL-MART STORES EAST LP
NPI: 1053338178
· BROKEN BOW, OK 74728
· 332B00000X
$300.03
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
26 |
$56.98 |
| 2019 |
15 |
$57.46 |
| 2020 |
38 |
$185.59 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose/reagent strips |
67 |
67 |
$222.27 |
| Q0513 |
Disp fee inhal drugs/30 days |
12 |
12 |
$77.76 |