Contract Details
Facility name
Special Formula Prescriptions
Provider ID
P000002436
NPI
1568527711
Tax ID
631245959
Effective Date
4/15/2004
Last Updated
11/8/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_105
Location Details
Address
3918 Montclair Road Suite 203
Birmingham, AL 35213
United States
County
Jefferson
Phone
2058717445 (Phone)
Billing Details
Address
3918 Montclair Road
Suite 203
Birmingham, AL 35213
Billing Phone
2058717445
Specialty Type
Pharmacy
Map
Address