WAL-MART STORES EAST LP
NPI: 1720112832
· PORT ST LUCIE, FL 34953
· 332B00000X
$165.33
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
87 |
$165.33 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0012A |
|
42 |
36 |
$108.39 |
| 0011A |
|
45 |
40 |
$56.94 |