WAL-MART STORES EAST LP
NPI: 1861637902
· GREENACRES, FL 33467
· Community/Retail Pharmacy
$120.00
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
53 |
$120.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0064A |
|
12 |
12 |
$40.00 |
| 0012A |
|
23 |
20 |
$40.00 |
| 0011A |
|
18 |
16 |
$40.00 |