WAL-MART STORES EAST LP
NPI: 1508884206
· WISCONSIN RAPIDS, WI 54494
· 332B00000X
$431.50
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
35 |
$431.50 |
| 2023 |
15 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90686 |
|
17 |
12 |
$431.50 |
| 90750 |
|
18 |
14 |
$0.00 |
| 90679 |
|
15 |
15 |
$0.00 |