Contract Details
Vital Care Home Infusion Services
Facility name
Med Center Pharmacy
Provider ID
P000002247
NPI
1144323403
Tax ID
630658459
Effective Date
8/25/2011
Last Updated
6/6/2016
Direct Contract
Yes
Term Date
8/30/2012
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
101 Samuel Moseley Drive
Selma, AL 36701
United States
County
Dallas
Phone
3348749495 (Phone)
Billing Details
Address
1170 Northeast Industrial Park Road
Meridian, MS 39301
Billing Phone
6014827420
Specialty Type
Home Infusion
Map
Address