Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

MOUNTAIN LAKE PHARMACY INC

NPI: 1336228006 · SUMMERSVILLE, WV 26651 · Pharmacy · NPI assigned 11/03/2006

$708.88
Total Medicaid Paid
88
Total Claims
79
Beneficiaries
1
Codes Billed
2020-01
First Month
2022-02
Last Month

Provider Details

Authorized OfficialBOONE, HOWARD (PRESIDENT PIC)
NPI Enumeration Date11/03/2006

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2020 30 $227.97
2021 40 $356.10
2022 18 $124.81

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
A4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips 88 79 $708.88