DE PERE HOMETOWN PHARMACY LLC
NPI: 1730749672
· DE PERE, WI 54115
· 332B00000X
$118.58
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
36 |
$118.58 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0001A |
|
17 |
12 |
$118.58 |
| 91300 |
|
19 |
13 |
$0.00 |