| Name | Value |
|---|---|
| PROVIDER TYPE | Suppliers |
| CLASSIFICATION | Pharmacy |
| DEFINITION | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. |
| AREA OF SPECIALIZATION | Compounding Pharmacy |
| STATUS | Active |
| X12 CODE | 3336C0004X |
| SPECIALTY CODE | A5 |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255519 |
| EFFECTIVE DATE/TIME |
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