Contract Details
Ancillary Care Services
Facility name
Pharmacy
Provider ID
P000005215
NPI
1730177668
Tax ID
611357805
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
82 Spruce Street
Murray, KY 42071
United States
County
Calloway
Phone
8662803494 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address