EXTENDED LIVING PHARMACY LLC
NPI: 1992899306
· FORSYTH, IL 62535
· Pharmacy
· NPI assigned 10/03/2006
$31.18
Total Medicaid Paid
Provider Details
| Authorized Official | AUBRY, JEFFREY (MANAGER) |
| NPI Enumeration Date | 10/03/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
13 |
$14.88 |
| 2019 |
15 |
$16.30 |
| 2021 |
355 |
$0.00 |
| 2022 |
258 |
$0.00 |
| 2023 |
17 |
$0.00 |
| 2024 |
115 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
15 |
13 |
$16.30 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
13 |
12 |
$14.88 |
| G0008 |
Administration of influenza virus vaccine |
57 |
36 |
$0.00 |
| 90656 |
|
58 |
37 |
$0.00 |
| 0064A |
|
386 |
386 |
$0.00 |
| 0012A |
|
17 |
17 |
$0.00 |
| 0134A |
|
53 |
53 |
$0.00 |
| 0004A |
|
45 |
45 |
$0.00 |
| 0124A |
|
58 |
58 |
$0.00 |
| 0054A |
|
71 |
71 |
$0.00 |