CVS STATE CAPITAL LLC
Pharmacy · PORTLAND, ME
Organization Active NPI 1427152347
Medicare payment data Part B · 2024
| Year | Beneficiaries | Services | Submitted | Allowed | Paid |
|---|---|---|---|---|---|
| 2024 | 425 | 1,476 | $121,189 | $117,019 | $117,019 |
| 2023 | 597 | 3,541 | $102,435 | $94,569 | $94,569 |
| 2022 | 645 | 3,799 | $72,960 | $65,803 | $65,803 |
Top procedures (2024)
| HCPCS | Description | Services | Avg allowed | Avg paid |
|---|---|---|---|---|
| 90480 | Admn sarscov2 vacc 1 dose | 398 | $42 | $42 |
| 91320 | Sarscv2 vac 30mcg trs-suc im | 382 | $148 | $148 |
| G0008 | Administration of influenza virus vaccine | 319 | $30 | $30 |
| 90662 | Influenza vaccine split virus, preservative free | 228 | $82 | $82 |
| 90653 | Influenza vaccine, inactivated | 56 | $82 | $82 |
| G0009 | Administration of pneumococcal vaccine | 21 | $28 | $28 |
| 90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 21 | $290 | $290 |
| 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 | 16 | $153 | $153 |
| 90673 | Influenza vaccine, trivalent derived from recombinant dna | 16 | $82 | $82 |
| 90656 | Influenza vaccine, trivalent, split virus, preservative-free, 0.5 ml dosage | 11 | $22 | $22 |
Taxonomy & licensure
| Specialty | Code | Primary | License | State |
|---|---|---|---|---|
| Pharmacy | 333600000X | ✓ | PH50000263 | 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.