CVS STATE CAPITAL LLC
Pharmacy · SOUTH PORTLAND, ME
Organization Active NPI 1003913583
Medicare payment data Part B · 2024
| Year | Beneficiaries | Services | Submitted | Allowed | Paid |
|---|---|---|---|---|---|
| 2024 | 604 | 2,030 | $165,631 | $161,725 | $161,725 |
| 2023 | 837 | 6,078 | $141,724 | $135,834 | $135,834 |
| 2022 | 962 | 6,268 | $107,357 | $98,016 | $98,016 |
Top procedures (2024)
| HCPCS | Description | Services | Avg allowed | Avg paid |
|---|---|---|---|---|
| 90480 | Admn sarscov2 vacc 1 dose | 551 | $38 | $38 |
| 91322 | Sarscov2 vac 50 mcg/0.5ml im | 538 | $155 | $155 |
| G0008 | Administration of influenza virus vaccine | 440 | $30 | $30 |
| 90662 | Influenza vaccine split virus, preservative free | 265 | $82 | $82 |
| 90653 | Influenza vaccine, inactivated | 142 | $82 | $82 |
| G0009 | Administration of pneumococcal vaccine | 24 | $30 | $30 |
| 90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 24 | $291 | $291 |
| 90656 | Influenza vaccine, trivalent, split virus, preservative-free, 0.5 ml dosage | 16 | $22 | $22 |
| 91304 | Severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5ml dosage, for intramuscular use | 13 | $156 | $156 |
| 90661 | Influenza vaccine, trivalent derived from cell cultures | 12 | $36 | $36 |
Taxonomy & licensure
| Specialty | Code | Primary | License | State |
|---|---|---|---|---|
| Pharmacy | 333600000X | ✓ | PH50000251 | ME |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — | |
| Community/Retail Pharmacy | 3336C0003X | — | — |
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Source: NPPES (public domain) and CMS Medicare Physician & Other Practitioners data. Not affiliated with CMS, NPPES, or any government agency.