Supplier
Frederick Ray Pharmacy LLC
Frederick Ray Pharmacy LLC was paid $42K by Medicaid between Apr 2020 and Apr 2022, across 2 billing codes. Its largest line is A4927, Gloves, non-sterile, per 100 — 60% of everything it billed.
33Billing provider infoFREDERICK RAY PHARMACY LLC
MOODUS, CT 06469
MOODUS, CT 06469
33aNPI1487298782assigned 10/30/2019
33bProvider typePharmacy
28Total paid$42K
24GClaims1,409
24DCodes billed2
24AFirst – last monthApr 2020 – Apr 2022
Compared with peers
Next to other Pharmacy providers in Connecticut
Rank by total paid#11 of 39
Median peer was paid$18K
This provider vs. median2.4×
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 | |
|---|---|---|---|
| 2020 | 896 | $33K | |
| 2021 | 430 | $8K | |
| 2022 | 83 | $2K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| A4927 | Gloves, non-sterile, per 100 | 60% | 1,292 | 1,207 | $25K |
| T4523 | Adult sized disposable incontinence product, brief/diaper, large, each | 40% | 117 | 117 | $17K |
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 officialTAVARES, DANIEL (PHARMACY MANAGER)
| Provider | Location | Paid |
|---|---|---|
| Grace Eldercare LLC | Franklin, NJ | $36K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.