NPI: 1689700379 · EAST PRAIRIE, MO 63845 · Community/Retail Pharmacy · NPI assigned 02/26/2007
| Authorized Official | JOHNSON, TERA (MANAGER) |
| NPI Enumeration Date | 02/26/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 100 | $0.00 |
| 2019 | 12 | $0.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| A4253 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips | 112 | 110 | $0.00 |