Covered Entity Details

DSH030022FM MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT (Active) - information as of 5/1/2025 11:46:46 PM

Main Details

Name

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Subdivision Name

Valleywise Behavior Health Center - Mesa Specialty Clinic - Behavioral Health Specialty Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH030022FM

Medicare Provider Number

030022

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/9/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/16/2024

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Maricopa County Special Health Care District
Michael White, Executive Vice President, Chief Clinical Officer
(602) 344-5503

Primary Contact

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE HEALTH
Alba Misty Vo, Director of Pharmacy
(602) 344-5253

Addresses

Street Address

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE BEHAVIORAL HEALTH CENTER - MESA
570 W BROWN RD
MESA, AZ 85201

Billing Address

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE HEALTH
2601 E ROOSEVELT ST
PHOENIX, AZ 85201

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
AZ	946301,20107,946310,946518,946347,946350,946277,946475,946194,946491,123461,946398. 946384,129589,03-0022,03-S022,03-2302,03-3504,355977,246641,161232,494996,176157,176432,080829,002977,176355,079434,096640	1003178229,1003233180,1003235896,1003273855,1013171263,1043679327,1073576740,1073916896,1073931218,1083033831,1104331115,1114346962,1114962438,1164840302,1174942924,1194736769,1205295581,1205871522,1215575824,1225456429,1285053066,1295154045,1306265145,1336568187,1356760102,1376169938,1427093632,1427476670,1518902725,1538588389,1548764657,1568407880,1619396462,1629497474,1669936472,1710922927,1730508524,1750906277,1821033044,1821415902,1851627541,1851750137,1861811614,1891114641,1902841224,1912275645,1952720708,1982022133,1093385031,1770167108,1124710199,1629840137,1851145809

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH030022AA	Child	DSH	MARICOPA MEDICAL CENTER	Comprehensive Health Center-Attendant Care Clinic	2525 East Roosevelt Street	Phoenix	AZ	Terminated
DSH030022AB	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / DIABETES EDUCATION 100301120	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AC	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / INTERNAL MEDICINE 100301001	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AD	Child	DSH	MARICOPA MEDICAL CENTER	MCDOWELL HEALTHCARE CENTER	1101N CENTRAL AVE 204	PHOENIX	AZ	Terminated
DSH030022AE	Child	DSH	MARICOPA MEDICAL CENTER	MARICOPA COUNTY SPECIAL HEALTH CARE	5825 E CALLE GUADALUPE	GUADALUPE	AZ	Terminated
DSH030022AF	Child	DSH	MARICOPA MEDICAL CENTER	EL MIRAGE FAMILY HEALTH CENTER	12428 W THUNDERBIRD	EL MIRAGE	AZ	Terminated
DSH030022AG	Child	DSH	MARICOPA MEDICAL CENTER	MARICOPA COUNTY SPECIAL HEALTH CARE	4011 N 51ST AVE	PHOENIX	AZ	Terminated
DSH030022AH	Child	DSH	MARICOPA MEDICAL CENTER	PENDERGAST FAMILY HEALTH CENTER	10550 W MARIPOSA STREET	PHOENIX	AZ	Terminated
DSH030022AJ	Child	DSH	MARICOPA MEDICAL CENTER	SEVENTH AVENUE FAMILY HEALTH CENTER	1205S 7TH AVE	PHOENIX	AZ	Terminated
DSH030022AK	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDIATRIC CARDIOLOGY 100301690	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AL	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDIATRIC PULMONARY 100301689	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AM	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDIATRIC SURGERY 100301630	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AN	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS BILIRUBIN 100301619	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AP	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS NUTRITION 100301610	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AQ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / SAME DAY CLINIC 100301003	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AR	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX/ DENTAL 100301700	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AS	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX/ DENTAL PEDS 100301699	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AT	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS 100301010	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AU	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / ADOLESCENT 100301013	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AV	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS RENAL 100301687	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AW	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS NEUROLOGY 100301686	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AX	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS INFECT DISEAS 100301685	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AY	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS GI 100301684	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022AZ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX/ PEDS ENDOCRINE 100301683	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022B	Child	DSH	MARICOPA MEDICAL CENTER	GLENDALE FAMILY HEALTH CENTER	5141 WEST LAMAR	GLENDALE	AZ	Terminated
DSH030022BA	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS RHEUMATOLOGY 100301679	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022BB	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS HEMATOLOGY 100301670	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022BC	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS ALLERGY 100301661	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022BD	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS PROCEDURE 100301640	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022BE	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX/ OB/GYN 100301020	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022BF	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS ORTHO 100301605	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022BG	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS GENETICS 100301601	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022BH	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PEDS PSYCHIATRY 100301600	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022BJ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER PEORIA / NEUROLOGY 100701077	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE COMPREHENSIVE HEALTH CENTER - PEORIA	PEORIA	AZ	Terminated
DSH030022BK	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - GLENDALE / OPHTHALMOLOGY 100404050	5141W LAMAR RD	GLENDALE	AZ	Terminated
DSH030022BL	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PEORIA / SURGICAL SPECIALTY CLINIC - PEORIA 100701030	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE COMPREHENSIVE HEALTH CENTER - PEORIA	PEORIA	AZ	Active
DSH030022BM	Child	DSH	MARICOPA MEDICAL CENTER	Pendergast Family Health Center / DENTAL CLINIC 100413700	10550 W MARIPOSA ST	PHOENIX	AZ	Terminated
DSH030022BN	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - NORTH PHOENIX / EYE SCREENING 100411056	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - NORTH PHOENIX	PHOENIX	AZ	Active
DSH030022BP	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - NORTH PHOENIX / OB/GYN 100411020	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE COMMUNITY HEALTH CENTER - NORTH PHOENIX	PHOENIX	AZ	Active
DSH030022BQ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - NORTH PHOENIX / INTERNAL MEDICINE 100411001	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - NORTH PHOENIX	PHOENIX	AZ	Active
DSH030022BR	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH PHOENIX/LAVEEN / DENTAL 100410700	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER SOUTH PHOENIX/LAVEEN	PHOENIX	AZ	Active
DSH030022BS	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH PHOENIX/LAVEEN / EYE SCREENING 100410056	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH PHOENIX/LAVEEN	PHOENIX	AZ	Active
DSH030022BT	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH PHOENIX/LAVEEN / OB/GYN 100410020	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER SOUTH PHOENIX/LAVEEN	PHOENIX	AZ	Active
DSH030022BU	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH PHOENIX/LAVEEN / PEDS 100410010	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH PHOENIX/LAVEEN	PHOENIX	AZ	Active
DSH030022BV	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH PHOENIX/LAVEEN/ INTERNAL MEDICINE 100410001	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH PHOENIX/LAVEEN	PHOENIX	AZ	Active
DSH030022BW	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH CENTRAL / OB/GYN 100409021	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - SOUTH CENTRAL	PHOENIX	AZ	Active
DSH030022BX	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MESA / DENTAL 100408700	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022BY	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MESA / NEUROLOGY 100408686	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022BZ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MESA / ENDOCRINE 100408683	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022C	Child	DSH	MARICOPA MEDICAL CENTER	SOUTH CENTRAL PRIMARY CARE CENTER	33 WEST TAMARISK	PHOENIX	AZ	Terminated
DSH030022CA	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MESA/ CARDIOLOGY 100408090	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022CB	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MESA / EYE SCREENING 100408056	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022CC	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MESA / SURGERY 100408030	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022CD	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MESA / OB/GYN 100408020	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022CE	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MESA / INTERNAL MEDICINE 100408001	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022CF	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL / RESEARCH 100407701	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL	PHOENIX	AZ	Active
DSH030022CG	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL / DENTAL 100407700	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL	PHOENIX	AZ	Active
DSH030022CH	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL/ Out-Patient PSYCH 100407100	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL	PHOENIX	AZ	Active
DSH030022CJ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL / INTERNAL MEDICINE 100407085	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL	PHOENIX	AZ	Active
DSH030022CK	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL / OB/GYN 100407020	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MCDOWELL	PHOENIX	AZ	Active
DSH030022CL	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE / PULMONARY 100406689	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE	PHOENIX	AZ	Active
DSH030022CM	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE / ENDOCRINE 100406683	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE	PHOENIX	AZ	Active
DSH030022CN	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE / ORTHO SPORTS MED 100406108	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE	PHOENIX	AZ	Active
DSH030022CP	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE/ NEUROLOGY 100406077	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE	PHOENIX	AZ	Active
DSH030022CQ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE/ EAR/NOSE/THROAT 100406061	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE	PHOENIX	AZ	Active
DSH030022CR	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE / AUDIOLOGY 100406060	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE	PHOENIX	AZ	Active
DSH030022CS	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE / OB/GYN 100406020	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - WEST MARYVALE	PHOENIX	AZ	Active
DSH030022CT	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - GUADALUPE / OB/GYN 100405020	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - GUADALUPE	GUADALUPE	AZ	Active
DSH030022CU	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PEORIA / CARDIOLOGY 100701090	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PEORIA	PEORIA	AZ	Active
DSH030022CV	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - GLENDALE / EYE SCREENING 100404056	5141W LAMAR RD	GLENDALE	AZ	Terminated
DSH030022CW	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PEORIA / DENTAL 100701700	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PEORIA	PEORIA	AZ	Active
DSH030022CX	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PEORIA / INTERNAL MEDICINE 100701001	8088 W WHITNEY DR	PEORIA	AZ	Terminated
DSH030022CY	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - EL MIRAGE/ CARDIOLOGY 100403090	12428 W THUNDERBIRD RD	EL MIRAGE	AZ	Terminated
DSH030022CZ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER / DENTAL 100402700	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER	CHANDLER	AZ	Active
DSH030022DA	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER / FAMILY PRACTICE 100402009	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER	CHANDLER	AZ	Active
DSH030022DB	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER / INTERNAL MEDICINE 100402001	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER	CHANDLER	AZ	Active
DSH030022DC	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE / DENTAL 100401700	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE	AVONDALE	AZ	Active
DSH030022DD	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE / MAMMOGRAPHY 100401111	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE	AVONDALE	AZ	Active
DSH030022DE	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE/ CARDIOLOGY 100401090	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE	AVONDALE	AZ	Active
DSH030022DF	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER / OB/GYN 100402020	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER	CHANDLER	AZ	Active
DSH030022DG	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER / EYE SCREENING 100402056	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER	CHANDLER	AZ	Active
DSH030022DH	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER / CARDIOLOGY 100402090	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - CHANDLER	CHANDLER	AZ	Active
DSH030022DJ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE / AUDIOLOGY 100401060	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE	AVONDALE	AZ	Active
DSH030022DK	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE / EYE SCREENING 100401056	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE	AVONDALE	AZ	Active
DSH030022DL	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE / OPHTHALMOLOGY 100401050	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE	AVONDALE	AZ	Active
DSH030022DM	Child	DSH	MARICOPA MEDICAL CENTER	COMPREHENSIVE HEALTHCARE CENTER / NUTRITION 100301410	2525 E ROOSEVELT ST	PHOENIX	AZ	Terminated
DSH030022DN	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / MINOR PROCEDURE 100301140	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DP	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX/ BONE DENSITY 100301119	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DQ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / MAMMOGRAPHY 100301111	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DR	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / ORTHO SPORTS MED 100301108	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DS	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / ORTHO TRAUMA 100301107	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DT	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / HAND/PLASTICS 100301106	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DU	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / CONGESTIVE HEART FAILURE CLINIC 100301092	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DV	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / CARDIOLOGY COAG 100301091	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DW	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX/ CARDIAC CLINIC 100301090	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DX	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / MED CLEARANCE 100301081	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DY	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / COAG CLINIC 100301080	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022DZ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / RHEUMATOLOGY 100301079	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022E	Child	DSH	MARICOPA MEDICAL CENTER	MESA FAMILY HEALTH CENTER	59 SOUTH HIBBERT	MESA	AZ	Terminated
DSH030022EA	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / INTERNAL MEDICINE - RENAL 100301078	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EB	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / NEUROLOGY 100301077	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EC	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / INFECTIOUS DISEASE 100301076	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022ED	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / GI 100301075	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EE	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / ENDOCRINE 100301074	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EF	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / DERMATOLOGY 100301073	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EG	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / MED SPECIAL PROCEDURES 100301071	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EH	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / HEMATOLOGY/ONCOLOGY 100301070	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EJ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / ENT HEAD & NECK 100301062	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EK	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / AUDIOLOGY 100301060	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EL	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / RETINA 100301055	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EM	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / OPTOMETRY 100301054	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EN	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX/ GLAUCOMA 100301053	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EP	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / EYE SPECIAL PROCEDURES 100301052	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EQ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / CORNEA 100301051	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022ER	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / BREAST CENTER 100301038	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022ES	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / VASCULAR 100301037	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022ET	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX / UROLOGY 100301036	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EU	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / REHAB 100301035	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EV	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PODIATRY 100301033	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EW	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PLASTICS 100301032	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EX	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / NEUROSURGERY 100301031	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EY	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / GYN TUMOR 100301022	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022EZ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / COLPOSCOPY 100301026	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022F	Child	DSH	MARICOPA MEDICAL CENTER	SUNNYSLOPE FAMILY HEALTH CENTER	934 WEST HATCHER	PHOENIX	AZ	Terminated
DSH030022FA	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / UROGYNECOLOGY 100301025	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022FB	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / OB/GYN INFERTILITY 100301024	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022FC	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / OBSTETRICS 100301023	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022FD	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE BEHAVIORAL HEALTH CENTER - MESA / CENTER OF EXCELLENCE (COE) 100202200 - Psychiatry	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE BEHAVIORAL HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022FE	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE BEHAVIORAL HEALTH CENTER - MESA / OUTPATIENT PSYCHIATRY 100202100 - Psychiatry	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE BEHAVIORAL HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022FF	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE BEHAVIORAL HEALTH CENTER - MESA / ASSERTIVE COMMUNITY TREATMENT (ACT) 100202300 - ACT Clinic	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE BEHAVIORAL HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022FG	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - MESA - Mesa Behavioral Health 100408610	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022FH	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE EMERGENCY - MARYVALE / Maryvale OP Services 105482	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE BEHAVIORAL HEALTH CENTER - MARYVALE	PHOENIX	AZ	Active
DSH030022FJ	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE / Integrated Behavioral Health Avondale	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMMUNITY HEALTH CENTER - AVONDALE	AVONDALE	AZ	Active
DSH030022FK	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	Valleywise Behavior Health Center - Maryvale Specialty Clinic - Behavioral Health Specialty Clinic	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE BEHAVIORAL HEALTH CENTER - MARYVALE	Phoenix	AZ	Active
DSH030022FL	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE HEALTH MOBILE HEALTH CLINIC - Mobile Health Clinic	MARICOPA COUNTY SPECIAL HEALTHCARE DISTRICT DBA VALLEYWISE HEALTH	Phoenix	AZ	Active
DSH030022FM	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	Valleywise Behavior Health Center - Mesa Specialty Clinic - Behavioral Health Specialty Clinic	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE BEHAVIORAL HEALTH CENTER - MESA	MESA	AZ	Active
DSH030022H	Child	DSH	MARICOPA MEDICAL CENTER	CHANDLER FAMILY HEALTH CENTER	811 SOUTH HAMILTON	CHANDLER	AZ	Terminated
DSH030022I	Child	DSH	MARICOPA MEDICAL CENTER	AVONDALE FAMILY HEALTH CENTER	950 EAST VAN BUREN	AVONDALE	AZ	Terminated
DSH030022J	Child	DSH	MARICOPA MEDICAL CENTER	COMPREHENSIVE HEALTHCARE CENTER / ORTHO 100301105	2525 E. Roosevelt	Phoenix	AZ	Terminated
DSH030022K	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / OPHTHALMOLOGY 100301050	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022L	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / EAR/NOSE/THROAT 100301061	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	Phoenix	AZ	Active
DSH030022M	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / SURGERY 100301030	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	Phoenix	AZ	Active
DSH030022N	Child	DSH	MARICOPA MEDICAL CENTER	Oncology Clinic/Infusion	2525 E. Roosevelt Street	Phoenix	AZ	Terminated
DSH030022P	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / DIALYSIS 100301200	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	Phoenix	AZ	Active
DSH030022Q	Child	DSH	MARICOPA MEDICAL CENTER	Comprehensive Health Center -Pedatric FHC Clinic (8361)	2525 East Roosevelt Street	Phoenix	AZ	Terminated
DSH030022R	Child	DSH	MARICOPA MEDICAL CENTER	COMPREHENSIVE HEALTHCARE CENTER / TELEMEDICINE 100301180	2525 East Roosevelt Street	Phoenix	AZ	Terminated
DSH030022T	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / NEUROPSYCHOLOGY 100301039	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	Phoenix	AZ	Active
DSH030022U	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / PULMONARY 100301082	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	PHOENIX	AZ	Active
DSH030022V	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / FAMILY PRACTICE 100301750	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	Phoenix	AZ	Active
DSH030022W	Child	DSH	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX / ANTEPARTUM TEST 100301150	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX	Phoenix	AZ	Active
DSH030022X	Child	DSH	MARICOPA MEDICAL CENTER	Comprehensive Health Center-Womens Center - Breast Clinic	2525 East Roosevelt Street	Phoenix	AZ	Terminated
DSH030022Y	Child	DSH	MARICOPA MEDICAL CENTER	Comprehensive Health Center-Women Center NS 12 FHC Clinic	2525 East Roosevelt Street	Phoenix	AZ	Terminated
DSH030022Z	Child	DSH	MARICOPA MEDICAL CENTER	Comprehensive Health Center-Women's Center FHC Clinic	2525 East Roosevelt Street	Phoenix	AZ	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Recertification	Valleywise Behavioral Health Center - Mesa 570 W Brown Rd Mesa, AZ 85201	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE BEHAVIORAL HEALTH CENTER - MESA 570 W BROWN RD MESA, AZ 85201	8/28/2024 10:46 AM
Addresses	Billing Address	Update	Recertification	Maricopa County Special Healthcare District Valleywise Health Behavioral Health - Mesa 2601 E Roosevelt St Phoenix, AZ 85201	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE HEALTH 2601 E ROOSEVELT ST PHOENIX, AZ 85201	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	030022 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	946467 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	946368 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	946384 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	324703 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	323650 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	320236 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	306301 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	363111 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	306426 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	320224 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	306616 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	306628 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	321113 (AZ)		8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		946398. 946384	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		129589	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		03-0022	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		03-S022	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		03-2302	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		03-3504	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		355977	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		246641	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		161232	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		494996	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		176157	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		176432	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		080829	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		002977	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		176355	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		079434	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		096640	8/28/2024 10:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1629840137	8/28/2024 10:46 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1851145809	8/28/2024 10:46 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	8/28/2024 10:46 AM
Details	Last Recertification Date	Update	Recertification		8/28/2024 10:46:19 AM	8/28/2024 10:46 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		White, Michael Executive Vice President, Chief Clinical Officer Maricopa County Special Health Care District 6023445503	2/16/2024 2:11 PM
Details	340B ID	Update	New Registration		DSH030022FM	2/16/2024 2:11 PM
Details	Entity Name	Update	New Registration	VALLEYWISE HEALTH MEDICAL CENTER	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	2/16/2024 2:11 PM
Details	Entity Subname	Update	New Registration	Valleywise Behavior Health Center - Mesa Specialty Clinic	Valleywise Behavior Health Center - Mesa Specialty Clinic - Behavioral Health Specialty Clinic	2/16/2024 2:11 PM
Dates	Participating Approval Date	Update	New Registration		2/16/2024 2:11:49 PM	2/16/2024 2:11 PM
Details	State	Update	New Registration	Pending	Approved	2/16/2024 2:11 PM
Dates	Signed By Date	Update	New Registration		2/5/2024 1:39:05 PM	2/16/2024 2:11 PM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/16/2024 2:11 PM
Addresses	Main Address	Insert	New Registration		Valleywise Behavioral Health Center - Mesa 570 W Brown Rd Mesa, AZ 85201	1/9/2024 6:47 PM
Addresses	Billing Address	Insert	New Registration		Maricopa County Special Healthcare District Valleywise Health Behavioral Health - Mesa 2601 E Roosevelt St Phoenix, AZ 85201	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		030022	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946301	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		20107	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946310	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946518	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946467	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946347	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946350	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946368	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946384	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946277	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946475	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946194	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		324703	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		323650	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		320236	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		306301	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		363111	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		306426	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		320224	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		306616	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		306628	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		321113	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		946491	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		123461	1/9/2024 6:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1003178229	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1003233180	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1003235896	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1003273855	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1013171263	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1043679327	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073576740	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073916896	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073931218	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083033831	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104331115	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1114346962	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1114962438	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1164840302	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1174942924	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1194736769	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1205295581	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1205871522	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1215575824	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1225456429	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285053066	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1295154045	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1306265145	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1336568187	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1356760102	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1376169938	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1427093632	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1427476670	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1518902725	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1538588389	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548764657	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1568407880	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619396462	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629497474	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1669936472	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1710922927	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1730508524	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1750906277	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1821033044	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1821415902	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1851627541	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1851750137	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1861811614	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1891114641	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1902841224	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1912275645	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1952720708	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1982022133	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1093385031	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1770167108	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124710199	1/9/2024 6:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/9/2024 6:47 PM
Contacts	Authorizing Official	Insert	New Registration		White, Michael Executive Vice President, Chief Clinical Officer Maricopa County Special Health Care District 6023445503	1/9/2024 6:47 PM
Contacts	Primary Contact	Insert	New Registration		Vo, Alba Misty Director of Pharmacy MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE HEALTH 6023445253	1/9/2024 6:47 PM
Details	Assistance Received From Date	Insert	New Registration			1/9/2024 6:47 PM
Details	Assistance Received To Date	Insert	New Registration			1/9/2024 6:47 PM
Details	Last Recertification Date	Insert	New Registration			1/9/2024 6:47 PM
Details	Grant Number	Insert	New Registration			1/9/2024 6:47 PM
Details	340B ID	Insert	New Registration			1/9/2024 6:47 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/9/2024 6:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/9/2024 6:47 PM
Details	Medicare Provider Number	Insert	New Registration		030022	1/9/2024 6:47 PM
Details	Entity Name	Insert	New Registration		VALLEYWISE HEALTH MEDICAL CENTER	1/9/2024 6:47 PM
Details	NOFO Number	Insert	New Registration			1/9/2024 6:47 PM
Details	Program Code	Insert	New Registration		DSH	1/9/2024 6:47 PM
Details	Entity Subname	Insert	New Registration		Valleywise Behavior Health Center - Mesa Specialty Clinic	1/9/2024 6:47 PM
Dates	Participating Approval Date	Insert	New Registration			1/9/2024 6:47 PM
Details	State	Insert	New Registration		Pending	1/9/2024 6:47 PM
Dates	Registration Date	Insert	New Registration		1/9/2024 6:47:50 PM	1/9/2024 6:47 PM
Dates	Signed By Date	Insert	New Registration			1/9/2024 6:47 PM
Dates	Start Date	Insert	New Registration			1/9/2024 6:47 PM
Terminations	Termination Comments	Insert	New Registration			1/9/2024 6:47 PM
Terminations	Termination Date	Insert	New Registration			1/9/2024 6:47 PM
Terminations	Termination Effective Date	Insert	New Registration			1/9/2024 6:47 PM
Terminations	Termination Reason	Insert	New Registration			1/9/2024 6:47 PM