WISCONSIN CVS PHARMACY LLC
NPI: 1376899120
· APPLETON, WI 54913
· 332B00000X
$643.74
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
24 |
$317.58 |
| 2019 |
17 |
$0.00 |
| 2020 |
14 |
$326.16 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90688 |
|
14 |
14 |
$326.16 |
| 90674 |
|
24 |
12 |
$317.58 |
| 90662 |
|
17 |
17 |
$0.00 |