WISCONSIN CVS PHARMACY LLC
NPI: 1366707390
· SUPERIOR, WI 54880
· 332B00000X
$532.40
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
13 |
$447.23 |
| 2021 |
12 |
$85.17 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90674 |
|
13 |
13 |
$447.23 |
| 0012A |
|
12 |
12 |
$85.17 |