WAL-MART STORES EAST LP
NPI: 1336166685
· MANSURA, LA 71350
· Pharmacy
· NPI assigned 07/16/2006
Billing Flags
· Automated signals — not evidence of fraud
Entity Proliferation
Authorized official CANONIC, KIMBERLY controls 20+ related entities in our dataset. Read more
$950.53
Total Medicaid Paid
Provider Details
| Authorized Official | CANONIC, KIMBERLY (SENIOR DIRECTOR, ENROLLMENT) |
| NPI Enumeration Date | 07/16/2006 |
Related Entities
Other providers sharing the same authorized official: CANONIC, KIMBERLY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
94 |
$269.69 |
| 2019 |
130 |
$173.03 |
| 2020 |
224 |
$459.25 |
| 2021 |
537 |
$48.56 |
| 2022 |
85 |
$0.00 |
| 2024 |
28 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
350 |
336 |
$950.53 |
| 90662 |
|
62 |
62 |
$0.00 |
| 0002A |
|
15 |
15 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
112 |
112 |
$0.00 |
| 0012A |
|
153 |
153 |
$0.00 |
| 90686 |
|
12 |
12 |
$0.00 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
69 |
67 |
$0.00 |
| 0011A |
|
234 |
222 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
13 |
13 |
$0.00 |
| 0064A |
|
78 |
78 |
$0.00 |