Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › NE › LA VISTA › YOUR HOMETOWN PHARMACY INC

YOUR HOMETOWN PHARMACY INC

NPI: 1548568769 · LA VISTA, NE 68128 · 3336L0003X

$164.01
Total Medicaid Paid
796
Total Claims
779
Beneficiaries
11
Codes Billed
2021-01
First Month
2024-10
Last Month

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2021 189 $49.35
2022 251 $37.31
2023 146 $77.35
2024 210 $0.00

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
90694 55 55 $77.35
0011A 80 72 $49.41
0001A 50 50 $37.25
G0008 Admin influenza virus vac 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