SELAH MOUNTAIN PHARMACY LLC
NPI: 1497211379
· PAGOSA SPRINGS, CO 81147
· Durable Medical Equipment & Medical Supplies
· NPI assigned 02/15/2019
$1.27M
Total Medicaid Paid
Provider Details
| Authorized Official | KUTZKO, JOHN (MANAGING MEMBER) |
| NPI Enumeration Date | 02/15/2019 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
124 |
$4K |
| 2023 |
155 |
$4K |
| 2024 |
9,454 |
$1.27M |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
9,348 |
8,580 |
$1.26M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
233 |
227 |
$14K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
124 |
113 |
$4K |
| T5999 |
Supply, not otherwise specified |
28 |
27 |
$0.00 |