WAL-MART STORES TEXAS LLC
NPI: 1174540330
· EAGLE PASS, TX 78852
· 332B00000X
$671.25
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
95 |
$375.04 |
| 2019 |
24 |
$296.21 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose/reagent strips |
77 |
77 |
$671.25 |
| 90662 |
|
20 |
20 |
$0.00 |
| G0008 |
Admin influenza virus vac |
22 |
22 |
$0.00 |