| Name | Value |
|---|---|
| PROVIDER TYPE | Suppliers |
| CLASSIFICATION | Pharmacy |
| DEFINITION | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| AREA OF SPECIALIZATION | Clinic Pharmacy |
| STATUS | Active |
| X12 CODE | 3336C0002X |
| SPECIALTY CODE | A5 |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255513 |
| EFFECTIVE DATE/TIME |
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