WAL-MART STORES EAST, LP
NPI: 1972684322
· STATE COLLEGE, PA 16803
· 156FX1800X
$480.00
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
26 |
$480.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
12 |
12 |
$480.00 |
| 92015 |
|
14 |
14 |
$0.00 |