WAL-MART STORES EAST, LP
NPI: 1750464095
· RIO RANCHO, NM 87124
· 156FX1800X
$714.50
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
27 |
$471.50 |
| 2023 |
14 |
$243.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
29 |
29 |
$478.50 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
12 |
12 |
$236.00 |