WAL-MART STORES EAST, LP.

NPI: 1295502979 · HARRISBURG, PA 17111 · Eyewear Supplier · NPI assigned 12/04/2023

$18K

Total Medicaid Paid

471

Total Claims

387

Beneficiaries

Codes Billed

2024-08

First Month

2024-12

Last Month

Provider Details

Authorized Official	GARVEY, MICHELE (DIRECTOR OF HEALTH CARE CONTRACTING)
NPI Enumeration Date	12/04/2023

Other providers sharing the same authorized official: GARVEY, MICHELE

Provider	City	State	Total Paid
WALMART INC.	HOMEWOOD	IL	$28K
WALMART INC.	NORTH LAS VEGAS	NV	$15K
WALMART INC.	RAPID CITY	SD	$8K
WAL-MART STORES EAST, LP.	LAS CRUCES	NM	$4K
WAL-MART STORES TEXAS, LLC	FORT WORTH	TX	$2K
WAL-MART STORES EAST, LP.	ALBUQUERQUE	NM	$1K

Year	Claims	Total Paid
2024	471	$18K

Code	Description	Claims	Beneficiaries	Total Paid
92004	Ophthalmological services: medical examination and evaluation, comprehensive, new patient	174	136	$7K
V2103	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens	70	61	$4K
V2025	Deluxe frame	47	47	$2K
V2115	Lenticular, (myodisc), per lens, single vision	22	12	$2K
V2020	Frames, purchases	121	95	$1K
V2781	Progressive lens, per lens	16	15	$1K
V2750	Anti-reflective coating, per lens	21	21	$89.00