WAL-MART STORES EAST LP
NPI: 1710904867
· FOND DU LAC, WI 54937
· 332B00000X
$866.01
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
23 |
$497.25 |
| 2021 |
13 |
$368.76 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90686 |
|
23 |
15 |
$497.25 |
| 0011A |
|
13 |
13 |
$368.76 |