MOMBA PHARMACY SERVICES LLC
NPI: 1386041655
· PITTSBURGH, PA 15212
· Community/Retail Pharmacy
· NPI assigned 12/02/2014
$938.52
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
32 |
$793.52 |
| 2023 |
13 |
$145.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
16 |
13 |
$507.52 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
16 |
13 |
$286.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$145.00 |