UPI (Provider ID): 1802
Change Report (if Any):

Short Name: COMPDRUG

Long Name 1: COMPDRUG
Long Name 2:

Address 1: 547 EAST 11TH AVENUE
Address 2:

City: COLUMBUS
Zip Code: 43211
County: FRAN

Contact: BELINDA KIMBLE
Title: DCS
Phone: 6142244506
FAX: 6142910118

Vendor: 1802

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 05/02/2012

File Produced: 19MAY2012