PENNSYLVANIA CVS PHARMACY, L.L.C.
NPI: 1376641993
· HAWLEY, PA 18428
· 332B00000X
$344K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
648 |
$0.00 |
| 2023 |
6,157 |
$3K |
| 2024 |
9,986 |
$341K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90750 |
|
605 |
598 |
$75K |
| 90661 |
|
1,869 |
1,863 |
$57K |
| 90471 |
|
7,471 |
7,367 |
$49K |
| 90739 |
|
276 |
274 |
$46K |
| 90656 |
|
1,482 |
1,481 |
$29K |
| 90677 |
|
130 |
130 |
$27K |
| 91320 |
|
251 |
251 |
$22K |
| 90715 |
|
318 |
317 |
$12K |
| 91322 |
|
127 |
127 |
$12K |
| 90472 |
|
590 |
569 |
$5K |
| 90679 |
|
126 |
125 |
$4K |
| 90662 |
|
202 |
201 |
$4K |
| 90674 |
|
1,603 |
1,602 |
$2K |
| 90686 |
|
1,311 |
1,308 |
$402.30 |
| 90694 |
|
50 |
50 |
$141.56 |
| G0008 |
Admin influenza virus vac |
297 |
295 |
$0.00 |
| 0134A |
|
19 |
19 |
$0.00 |
| 0124A |
|
64 |
63 |
$0.00 |