KEYSTONE RX CORPORATION INC
NPI: 1922411925
· HEMINGFORD, NE 69348
· Long Term Care Pharmacy
· NPI assigned 06/06/2014
$4.54
Total Medicaid Paid
Provider Details
| Authorized Official | RANDOLPH, DAVID (PRESIDENT) |
| NPI Enumeration Date | 06/06/2014 |
Related Entities
Other providers sharing the same authorized official: RANDOLPH, DAVID
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
18 |
$0.00 |
| 2019 |
17 |
$0.00 |
| 2020 |
60 |
$0.00 |
| 2021 |
46 |
$0.00 |
| 2022 |
46 |
$0.41 |
| 2023 |
79 |
$4.13 |
| 2024 |
109 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90688 |
|
79 |
79 |
$3.77 |
| 0134A |
|
13 |
13 |
$0.77 |
| 91322 |
|
33 |
33 |
$0.00 |
| 90653 |
|
17 |
17 |
$0.00 |
| 90756 |
|
30 |
30 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
170 |
170 |
$0.00 |
| 90480 |
|
33 |
33 |
$0.00 |