YOUR HOMETOWN PHARMACY INC
NPI: 1548568769
· LA VISTA, NE 68128
· Long Term Care Pharmacy
· NPI assigned 03/11/2011
$164.01
Total Medicaid Paid
Provider Details
| Authorized Official | HALL, KODY (CEO/OWNER) |
| NPI Enumeration Date | 03/11/2011 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
189 |
$49.35 |
| 2022 |
251 |
$37.31 |
| 2023 |
146 |
$77.35 |
| 2024 |
210 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90694 |
|
55 |
55 |
$77.35 |
| 0011A |
|
80 |
72 |
$49.41 |
| 0001A |
|
50 |
50 |
$37.25 |
| G0008 |
Administration of influenza virus vaccine |
126 |
126 |
$0.00 |
| 91301 |
|
83 |
75 |
$0.00 |
| 90480 |
|
82 |
82 |
$0.00 |
| 91322 |
|
82 |
82 |
$0.00 |
| 90653 |
|
48 |
48 |
$0.00 |
| 91300 |
|
58 |
57 |
$0.00 |
| 0124A |
|
66 |
66 |
$0.00 |
| 91312 |
|
66 |
66 |
$0.00 |