Momba Pharmacy Services LLC

Momba Pharmacy Services LLC was paid $938.52 by Medicaid between Jan 2022 and Oct 2023, across 3 billing codes. Its largest line is 87635, Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe — 54% of everything it billed.

33Billing provider infoMOMBA PHARMACY SERVICES LLC
PITTSBURGH, PA 15212

33aNPI1386041655assigned 12/02/2014

33bProvider typeCommunity/Retail Pharmacy

28Total paid$938.52

24GClaims45

24DCodes billed3

24AFirst – last monthJan 2022 – Oct 2023

Compared with peers

Next to other Community/Retail Pharmacy providers in Pennsylvania

Rank by total paid#15 of 44

Median peer was paid$461.37

This provider vs. median2.0×

Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2022	32	$793.52
2023	13	$145.00

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
87635	Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe	54%	16	13	$507.52
99211	Office or other outpatient visit for the evaluation and management of an established patient, minimal severity	30%	16	13	$286.00
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	15%	13	13	$145.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialDEPASQUALE, FRED (DEPASQUALE)