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NPI 1013998921 · Redlands, CA · Specialty Pharmacy
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Caremark, L.L.C. is a specialty pharmacy provider located in Redlands, California. This profile covers 2 Medicare and 22 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Caremark, L.L.C. |
| Address | 1127 Bryn Mawr Ave. |
| City | Redlands |
| State | CA |
| ZIP | 92374 |
| Taxonomy | Specialty Pharmacy |
| NPI Enumerated | November 8, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $19.9M |
| Medicare | $13.4M |
CAREMARK, L.L.C. bills meaningfully to both Medicare and Medicaid, with lifetime Medicare revenue of $13.4M and lifetime Medicaid revenue of $19.9M; Medicaid is the larger payer for this provider by dollar volume, so state program reimbursement and policy will likely drive more of its topline than Medicare. This is not a single-payer operation — both payers contribute material revenue, but Medicaid exceeds Medicare in scale.
Medicare revenue is extremely concentrated: the precomputed top-3 Medicare CPT/HCPCS codes account for 100.0% of the provider's Medicare revenue, and the two listed codes J7170 ($7.3M, 58.4%) and J7192 ($5.2M, 41.6%) together represent the entirety of reported Medicare billing. That concentration indicates CAREMARK’s Medicare business is essentially defined by a very small set of specialty biologic administrations.
The code mix across both payers is consistent with a specialty pharmacy and home-infusion operation: high-revenue injectable biologics and clotting factor therapy appear centrally (J7170, J7192), while Medicaid lines show pulmonary vasodilator therapy (J3285), long-acting contraceptive devices (J7298, J7307), and immunoglobulin or biologic therapies (90378, J2357). This pattern suggests the organization focuses on dispensing and often coordinating administration of complex, high-cost injectable therapies and durable drug-delivery services rather than routine retail pharmacy volume.
CAREMARK holds a strong competitive position nationally on at least one Medicare product: J7192 ranks #1 of 7 providers nationally (100th percentile; notably above typical national volume), signaling market leadership in recombinant factor VIII dispensing. By contrast, J7170 ranks #2 of 6 (80th percentile; typical, unremarkable volume), indicating solid but not dominant national standing for emicizumab administrations.
On the Medicaid side CAREMARK shows leading in-state placement for specific therapies: J3285 (treprostinil) is $8.9M (44.9% of Medicaid revenue) and ranks #1 of 2 providers in-state (100th percentile; typical, unremarkable volume), while J7298 (levonorgestrel IUD) is $2.8M (14.0%) and ranks #2 of 90 in-state (99th percentile; notably above typical state volume). Those rankings suggest the provider is an important state-level supplier for pulmonary hypertension therapy and a high-volume dispenser of intrauterine contraceptive systems relative to most peers.
Medicaid revenue is moderately concentrated: the precomputed top-3 Medicaid CPT/HCPCS codes account for 67.6% of the provider's Medicaid revenue, with J3285 alone making up $8.9M (44.9%). This degree of dependence on a small number of high-cost products means shifts in utilization, reimbursement, or product availability for those codes could have outsized effects on the provider’s Medicaid revenue.
The provider has an established operational history, with an NPI enumeration date of 2005-11-08 (~21 years ago), which supports the interpretation that its specialty dispensing and infusion services are longstanding rather than a recent build-out. Tenure of this length increases the plausibility of durable payer relationships and experience managing complex biologic therapies.
Beyond dispensing of specific drugs, the presence of codes for home infusion and supplies (S9347, A4222, A4221) alongside many high-cost biologic codes indicates CAREMARK likely provides ancillary infusion coordination, equipment, and professional pharmacy services in addition to product supply. This breadth implies a service model that bundles product distribution with care coordination and delivery logistics for complex outpatient therapies.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J3285 | Injection, treprostinil, 1 mg | 2,820 | $3,170 | $8.9M |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg | 2,910 | $960 | $2.8M |
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies | 1,700 | $1,020 | $1.7M |
| J2357 | Injection, omalizumab, 5 mg | 810 | $1,870 | $1.5M |
| Z5999 | N/A | 50 | $28,940 | $1.5M |
| 90378 | Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial… | 540 | $2,690 | $1.4M |
| S9347 | Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy (e.g., epoprostenol); administrative services, professional pharmacy services, care… | 670 | $1,010 | $673.6K |
| J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | 180 | $2,110 | $383.8K |
| J0135 | Injection, adalimumab, 20 mg | 370 | $910 | $333.8K |
| J3590 | Unclassified biologics | 310 | $660 | $202.3K |
Showing 1–10 of 22
How this provider's Medicaid billing volume and revenue compare to other California providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. California median
22 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J3285 | Injection, treprostinil, 1 mg | 1 | 10 | 2,350 | $5,300 | $12.5M |
| Z5999 | N/A | 17 | 20 | 3,330 | $380 | $2M |
| S9347 | Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy (e.g., epoprostenol); administrative services, professional pharmacy services, care… | 2 | 10 | 1,690 | $890 | $1.5M |
| 90378 | Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial… | 4 | 20 | 220 | $2,520 | $1.3M |
| J0135 | Injection, adalimumab, 20 mg | 8 | 20 | 130 | $2,450 | $809.4K |
| J1438 | Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 5 | 10 | 120 | $1,490 | $436.9K |
| J2357 | Injection, omalizumab, 5 mg | 4 | 10 | 110 | $800 | $419.1K |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 97 | 110 | 260 | $590 | $407.4K |
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies | 10 | 250 | 120 | $850 | $378K |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg | 2 | 90 | 60 | $740 | $268.1K |
Showing 1–10 of 22
Other providers in the same ZIP code as Caremark, L.L.C., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| San Bernardino Medical Orthopaedic Group, Inc. | CA | Orthopaedic Surgery Physician | $0 | $60.1M |
| Eric Chin | CA | Retina Specialist (Ophthalmology) Physician | $1.8M | $0 |
| Archis Desai | CA | Internal Medicine Physician | $530.8K | $0 |
| Madhu Agarwal | CA | Ophthalmology Physician | $478.9K | $0 |
| Kenneth Jordan | CA | Neurology Physician | $103.7K | $0 |
| Brianna Crawley | CA | Otolaryngology Physician | $100.4K | $0 |
| Kristin Seiberling | CA | Otolaryngology Physician | $97.6K | $0 |
| Priya Krishna | CA | Specialist | $72.4K | $0 |
| Reignette Yang | CA | Speech-Language Pathologist | $50.2K | $0 |
| Christina Liem | CA | Speech-Language Pathologist | $20.9K | $0 |
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