ROCKY MOUNTAIN PHARMACY, LLC
NPI: 1851923544
· IDAHO FALLS, ID 83404
· 332B00000X
$342K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
101 |
$20K |
| 2023 |
1,533 |
$199K |
| 2024 |
734 |
$123K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Non-adju cgm supply allow |
1,571 |
1,370 |
$296K |
| K0553 |
Ther cgm supply allowance |
101 |
86 |
$20K |
| A4224 |
Supply insulin inf cath/wk |
300 |
280 |
$14K |
| A4225 |
Sup/ext insulin inf pump syr |
325 |
311 |
$8K |
| A9277 |
External transmitter, cgm |
17 |
16 |
$2K |
| A4215 |
Sterile needle |
13 |
13 |
$375.00 |
| A4253 |
Blood glucose/reagent strips |
27 |
25 |
$360.88 |
| A9276 |
Disposable sensor, cgm sys |
14 |
14 |
$0.00 |