HOMETOWN LONG TERM CARE PHARMACY LLC
NPI: 1659634988
· SUN PRAIRIE, WI 53590
· Pharmacy
· NPI assigned 06/21/2012
$159K
Total Medicaid Paid
Provider Details
| Authorized Official | DEANS, DIANE (CONTRACTING SPECIALIST) |
| NPI Enumeration Date | 06/21/2012 |
Related Entities
Other providers sharing the same authorized official: DEANS, DIANE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
118 |
$1K |
| 2023 |
39 |
$4K |
| 2024 |
4,920 |
$154K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9150 |
Non-prescription drugs |
4,989 |
1,270 |
$154K |
| 91322 |
|
26 |
24 |
$3K |
| 90674 |
|
13 |
13 |
$555.87 |
| 0002A |
|
17 |
17 |
$479.24 |
| 90756 |
|
13 |
13 |
$299.07 |
| 91300 |
|
19 |
19 |
$0.00 |