WAL-MART STORES EAST LP
NPI: 1750309605
· SULLIVAN, IN 47882
· 332B00000X
$376.04
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
25 |
$0.00 |
| 2019 |
64 |
$101.50 |
| 2020 |
39 |
$241.27 |
| 2021 |
60 |
$33.27 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose/reagent strips |
106 |
105 |
$376.04 |
| G0008 |
Admin influenza virus vac |
34 |
34 |
$0.00 |
| 0064A |
|
35 |
35 |
$0.00 |
| 90662 |
|
13 |
13 |
$0.00 |