| PROVIDER | NAME | ||||||||
| 119801 | SAMARITAN SERVICES | ||||||||
| Unit | S/A | ||||||||
| Srvc Cat | Service Desc | RU | FS | PA | Eff Date | Lap Date | Rate | Descr | Code |
| 13240000 | SOC REHAB | 5038 | 38 | Y | 7/1/2001 | 06/30/10 | 25.00 | Hour | 1324 |
| 15520000 | HOUSE SUP/SUP LIVING | 5038 | 38 | Y | 7/1/2001 | 06/30/10 | 25.00 | Hour | 1552 |
| 15530000 | COMMUNITY COUNSELING | 5038 | 38 | Y | 7/1/2001 | 06/30/10 | 50.00 | Hour | 1553 |
| 13800000 | MEDICATION MONITORING | 5038 | 38 | Y | 7/1/2003 | 06/30/10 | 25.00 | Hour | 1380 |