NPI: 1164804795 · SALMON, ID 83467 · Community/Retail Pharmacy · NPI assigned 06/19/2015
| Authorized Official | CARDONA, ALLISON (PHARMACY MANAGER) |
| NPI Enumeration Date | 06/19/2015 |
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 12 | $194.68 |
| 2021 | 13 | $163.06 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| A4253 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips | 25 | 24 | $357.74 |