Contract Details
Vital Care Home Infusion Services
Facility name
Southeast Pharmaceuticals
Provider ID
P000002415
NPI
1427167477
Tax ID
631134860
Effective Date
8/25/2011
Last Updated
6/9/2014
Direct Contract
Yes
Term Date
9/16/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
704 Troy Highway Suite A
Elba, AL 36323
United States
County
Coffee
Phone
3348973746 (Phone)
Billing Details
Address
1170 Northeast Industrial Park Road
Meridian, MS 39301
Billing Phone
6014827420
Specialty Type
Home Infusion
Map
Address