Contract Details
Ancillary Care Services
Facility name
Holmes Pharmacy
Provider ID
P000004575
NPI
1457352015
Tax ID
200337383
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
600 South Main Street
Borger, TX 79007
United States
County
Hutchinson
Phone
8062745334 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address