FOODLAND SUPERMARKET LTD
NPI: 1972775997
· LAIE, HI 96762
· Community/Retail Pharmacy
· NPI assigned 03/31/2008
$125.60
Total Medicaid Paid
Provider Details
| Authorized Official | ADAMS, PATRICK (DIR OF PHCY) |
| NPI Enumeration Date | 03/31/2008 |
Related Entities
Other providers sharing the same authorized official: ADAMS, PATRICK
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
12 |
$125.60 |
| 2021 |
16 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$125.60 |
| 91300 |
|
16 |
12 |
$0.00 |