WAL-MART STORES EAST, LP.

NPI: 1417724733 · LEBANON, PA 17046 · Eyewear Supplier · NPI assigned 12/06/2023

$30K

Total Medicaid Paid

782

Total Claims

662

Beneficiaries

Codes Billed

2024-03

First Month

2024-12

Last Month

Provider Details

Authorized Official	GARVEY, MICHELE (DIRECTOR OF HEALTH CARE CONTRACTING)
NPI Enumeration Date	12/06/2023

Other providers sharing the same authorized official: GARVEY, MICHELE

Provider	City	State	Total Paid
WALMART INC.	HOMEWOOD	IL	$28K
WAL-MART STORES EAST, LP.	HARRISBURG	PA	$18K
WALMART INC.	NORTH LAS VEGAS	NV	$15K
WALMART INC.	RAPID CITY	SD	$8K
WAL-MART STORES EAST, LP.	LAS CRUCES	NM	$4K
WAL-MART STORES TEXAS, LLC	FORT WORTH	TX	$2K
WAL-MART STORES EAST, LP.	ALBUQUERQUE	NM	$1K

Year	Claims	Total Paid
2024	782	$30K

Code	Description	Claims	Beneficiaries	Total Paid
V2103	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens	119	84	$8K
92014	Ophthalmological services: medical examination and evaluation, comprehensive, established patient	185	163	$7K
V2115	Lenticular, (myodisc), per lens, single vision	57	46	$5K
V2020	Frames, purchases	288	252	$4K
92002		106	90	$4K
V2799	Vision item or service, miscellaneous	15	15	$75.00
92015	Determination of refractive state	12	12	$0.00