KIMBERLY HOMETOWN PHARMACY LLC
NPI: 1295291045
· APPLETON, WI 54915
· Specialty Pharmacy
· NPI assigned 02/18/2019
$457.92
Total Medicaid Paid
Provider Details
| Authorized Official | DEANS, DIANE (CONTRACTING MANAGER) |
| NPI Enumeration Date | 02/18/2019 |
Related Entities
Other providers sharing the same authorized official: DEANS, DIANE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
34 |
$457.92 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0001A |
|
12 |
12 |
$457.92 |
| 91300 |
|
22 |
12 |
$0.00 |