Supplier
Super Farmacia Lizette, INC
Super Farmacia Lizette, INC was paid $4K by Medicaid between Oct 2019 and Dec 2019, across 4 billing codes. Its largest line is 90670, — 66% of everything it billed.
33Billing provider infoSUPER FARMACIA LIZETTE, INC
JAYUYA, PR 00664
JAYUYA, PR 00664
33aNPI1679506125assigned 07/08/2006
33bProvider typePharmacy
28Total paid$4K
24GClaims160
24DCodes billed4
24AFirst – last monthOct 2019 – Dec 2019
Compared with peers
Next to other Pharmacy providers in Puerto Rico
Rank by total paid#6 of 10
Median peer was paid$4K
This provider vs. median1.0×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2019 | 160 | $4K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 90670 | 66% | 15 | 15 | $2K | |
| 90686 | 34% | 65 | 65 | $1K | |
| G0008 | Administration of influenza virus vaccine | 0% | 65 | 65 | $0.00 |
| G0009 | Administration of pneumococcal vaccine | 0% | 15 | 15 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialRIVERA, LIZETTE (OWNER)