Claysville Pharmacy LLC
Claysville Pharmacy LLC was paid $275.00 by Medicaid between Oct 2023 and Oct 2024, across 1 billing code. Its largest line is 90471, Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine — 100% of everything it billed.
33Billing provider infoCLAYSVILLE PHARMACY LLC
CLAYSVILLE, PA 15323
CLAYSVILLE, PA 15323
33aNPI1134159536assigned 07/03/2006
33bProvider typeDiabetes Educator Registered Nurse
28Total paid$275.00
24GClaims28
24DCodes billed1
24AFirst – last monthOct 2023 – Oct 2024
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2023 | 16 | $143.00 | |
| 2024incomplete | 12 | $132.00 |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 100% | 28 | 28 | $275.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialCUSHEY, ERICH (OWNER)