Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › PR › LARES › FARMACIA SAN JOSE LLC

FARMACIA SAN JOSE LLC

NPI: 1699763326 · LARES, PR 00669 · Community/Retail Pharmacy · NPI assigned 10/06/2005

$12K
Total Medicaid Paid
1,363
Total Claims
1,141
Beneficiaries
6
Codes Billed
2018-02
First Month
2021-12
Last Month

Provider Details

Authorized OfficialJIMENEZ, FRANCISCO (PRESIDENT)
NPI Enumeration Date10/06/2005

Related Entities

Other providers sharing the same authorized official: JIMENEZ, FRANCISCO

ProviderCityStateTotal Paid
LATINO HEALTH SERVICES MEDICAL GROUP INC SANTA ANA CA $6.43M
AZUL MEDICAL CLINIC INC BELL GARDENS CA $6K
BEAR VALLEY CLINICA FAMILIAR, INC VICTORVILLE CA $5K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 804 $6K
2019 384 $5K
2020 110 $284.15
2021 65 $272.88

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
90670 42 37 $3K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 620 491 $3K
90686 451 401 $3K
90732 60 56 $2K
90472 Immunization administration, each additional vaccine (list separately) 154 120 $715.78
90715 36 36 $12.00