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NPI 1023630662 · Billings, MT · Community/Retail Pharmacy
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Pharm406 Inc is a community/retail pharmacy provider located in Billings, Montana. This profile covers 12 Medicare and 21 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 | Pharm406 Inc |
| Address | 1410 38th St W Ste A |
| City | Billings |
| State | MT |
| ZIP | 59102 |
| Taxonomy | Community/Retail Pharmacy |
| NPI Enumerated | May 16, 2020 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $508.2K |
| Medicaid | $425.4K |
PHARM406 INC operates as a community/retail pharmacy with Medicare billing dominated by vaccine administration and COVID-19 immunization services. The top Medicare codes are 91322 (975 claims, $143 avg paid/claim, $139.4K revenue, 27.5%), 90694 (1.6K claims, $76 avg paid/claim, $117.8K revenue, 23.2%), and 91304 (448 claims, $145 avg paid/claim, $65K revenue, 12.8%), which together account for the precomputed 63.5% of the provider's total Medicare revenue. This mix indicates a primary operational focus on adult immunizations (COVID-19 and influenza) alongside routine vaccine administration services.
Medicaid revenue is heavily concentrated in durable medical supplies for diabetes management rather than vaccines. The top Medicaid codes are A9274 (502 claims, $526 avg paid/claim, $264.1K revenue, 62.0%) and A4239 (586 claims, $211 avg paid/claim, $123.6K revenue, 29.0%); together with a third-ranked code these top three account for the precomputed 93.1% of this provider's total Medicaid revenue, signaling a dominant DME/supply line for insulin delivery and CGM supplies in the Medicaid book.
The provider’s payer mix shows Medicare slightly exceeds Medicaid in scale, with lifetime Medicare revenue of $508.2K versus Medicaid revenue of $425.4K. While both payers are material, the revenue composition differs markedly: Medicare receipts are vaccine-centric, whereas Medicaid receipts are concentrated in high-value diabetes supply codes.
PHARM406 INC’s Medicare competitive standing is mixed by code: 91304 is an extreme outlier (ranks #1 of 495 nationally), indicating far above‑typical national volume for that specific COVID-19 vaccine product; 90694 ranks #23 of 51679 (100th percentile) and is described as notably above typical national volume; 91322 ranks #61 of 29357 (100th percentile) but is characterized as typical, unremarkable volume. These rankings suggest the pharmacy is a major dispenser of certain COVID-19 and flu vaccine products at the national level while exhibiting typical activity on other vaccine lines.
On Medicaid the provider appears regionally prominent for diabetes supply codes. A9274 is listed as #1 of 1 in-state (no peer comparison available) and contributes $264.1K (62.0%) of Medicaid revenue, and A4239 ranks #2 of 24 in-state (96th percentile) contributing $123.6K (29.0%), together driving nearly all Medicaid revenue — this positions the provider as a primary in-state source for ambulatory insulin delivery systems and CGM supplies.
Several codes flagged as statistical outliers reinforce concentrated service lines: Medicare 91304 is labeled an "extreme outlier, far above typical national volume," and Medicaid shows 0011A as #1 of 25 (100th percentile; extreme outlier) along with A4239 being "notably above typical state volume." These labels indicate unusually high dispensing or billing activity on a small number of codes rather than broad-based service diversity.
Operational tenure is short-to-moderate: the NPI was enumerated on 2020-05-16 (~6 years ago), so the billing profile reflects activity from a relatively recent entrant to the national provider file. Given this timeframe, the rapid emergence as a high-volume reporter on specific vaccine and diabetes-supply codes suggests focused service-line growth rather than a long legacy of diversified billing.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 91322 | This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 50 mcg/0.5 mL. | 980 | $140 | $139.4K |
| 90694 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is an inactivated, adjuvanted, preservative–free vaccine given as a 0.5 mL… | 1,550 | $80 | $117.8K |
| 91304 | This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to prevent the patient from contracting COVID–19. The dosage is 5 mcg/0.5 mL. | 450 | $150 | $65K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 1,420 | $40 | $56.8K |
| G0008 | Administration of influenza virus vaccine | 1,640 | $30 | $49.1K |
| 90677 | This code represents a vaccine product administered intramuscularly to protect against pneumococcal disease, a bacterial infection. This is a 20–valent vaccine, protecting against 20 strains of the… | 170 | $280 | $47.7K |
| 0124A | N/A | 250 | $40 | $10.3K |
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 580 | $10 | $6.9K |
| G0009 | Administration of pneumococcal vaccine | 170 | $30 | $5.1K |
| 0134A | N/A | 100 | $40 | $4K |
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How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
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.
21 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories | 500 | $530 | $264.1K |
| A4239 | Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 590 | $210 | $123.6K |
| 0001A | N/A | 310 | $30 | $8.8K |
| 0011A | N/A | 530 | $20 | $8.5K |
| 0012A | N/A | 350 | $20 | $8K |
| 0002A | N/A | 240 | $30 | $7.5K |
| 0003A | N/A | 280 | $10 | $2K |
| 0064A | N/A | 110 | $10 | $1.1K |
| 0071A | N/A | 20 | $40 | $840 |
| 0013A | N/A | 50 | $10 | $610 |
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How this provider's Medicaid billing volume and revenue compare to other Montana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Montana median
21 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories | 1 | 10 | 500 | $530 | $263.9K |
| A4239 | Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 2 | 20 | 180 | $170 | $38.6K |
| 0001A | N/A | 4 | 30 | 50 | $20 | $3.6K |
| 0002A | N/A | 5 | 30 | 40 | $30 | $3.4K |
| 0064A | N/A | 2 | 10 | 50 | $30 | $2.7K |
| 0031A | N/A | 2 | 10 | 40 | $30 | $2.2K |
| 0071A | N/A | 8 | 10 | 30 | $30 | $2.1K |
| 0012A | N/A | 2 | 30 | 40 | $20 | $1.5K |
| 0011A | N/A | 1 | 30 | 50 | $10 | $1.4K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 20 | 40 | 30 | $20 | $1K |
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Other providers in the same ZIP code as Pharm406 Inc, ranked by combined Medicare and Medicaid revenue.
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