VANDORN PHARMACY INC
NPI: 1174151716
· ALEXANDRIA, VA 22304
· Long Term Care Pharmacy
· NPI assigned 03/30/2020
$400.23
Total Medicaid Paid
Provider Details
| Authorized Official | GULELAT, YODIT (OWNER/MANAGER) |
| Parent Organization | VANDORN PHARMACY INC |
| NPI Enumeration Date | 03/30/2020 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
76 |
$28.39 |
| 2023 |
48 |
$371.84 |
| 2024 |
66 |
$0.00 |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 91322 |
|
39 |
36 |
$291.84 |
| 90480 |
|
39 |
36 |
$80.00 |
| 0012A |
|
25 |
25 |
$28.39 |
| 0004A |
|
24 |
24 |
$0.00 |
| 90662 |
|
12 |
12 |
$0.00 |
| M0201 |
Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home |
12 |
12 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| 0011A |
|
27 |
27 |
$0.00 |