MOUNTAIN STREET PHARMACY INC
NPI: 1447316716
· KINGS MOUNTAIN, NC 28086
· Pharmacy
· NPI assigned 12/29/2006
$650.00
Total Medicaid Paid
Provider Details
| Authorized Official | PROPST, ALLAN (PRESIDENT) |
| NPI Enumeration Date | 12/29/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
32 |
$650.00 |
| 2022 |
30 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0013A |
|
16 |
14 |
$650.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |
| 901301 |
|
16 |
14 |
$0.00 |
| 90686 |
|
16 |
15 |
$0.00 |