340B Drug Pricing Program Database


DSH030064 Banner - University Medical Center Tucson (Active) - information as of 5/16/2025 11:29:33 PM

Main Details
Banner - University Medical Center Tucson
Disproportionate Share Hospital
Yes
DSH030064
030064


Additional Details
Active
10/24/2006
1/1/1997
10/24/2006
8/12/2024

Contacts

Banner Health
Meiko Onken, Chief Operating Officer
(602) 625-2651

Banner University Medical Center Tucson
Kurt Weibel, Director of Pharmacy Services
(520) 694-6061

Addresses

1625 North Campbell Avenue
TUCSON, AZ 85719

Banner Health Accounts Payable
PO Box 2977
Phoenix, AZ 85062


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
1/11/12 Add New bill to address, Change AO and PC JH10/24/2006
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
AZ005638,9884391265820179,1508809427
Shipping Addresses

Banner - University Medical Center Tucson
1501 N Campbell Ave Rm 0325
Attn: CAR-T
Tucson, AZ 85724

Banner University Medical Center - Tucson
1625 N Campbell Ave
Tucson, AZ 85719

SafeCor Health
4060 Business Park Drive
Columbus, OH 43204-5046
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/11/201910/01/2019  10/01/2019
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/11/201910/01/2019  10/01/2019
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/11/201910/01/2019  10/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/11/201910/01/2019 07/01/202301/24/2025
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/11/201910/01/2019  10/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/11/201910/01/2019  10/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.11411 STRANG LINE RD STE A
LENEXAKS6621504/13/202307/01/2023  07/01/2023
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/13/202307/01/2023  07/01/2023
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280901/17/201804/01/2018  01/17/2018
Contract DetailALBERTSON'S LLCOSCO DRUG #961 2854 NORTH CAMPBELL
TUCSONAZ8571907/20/201810/01/2018  10/01/2018
Contract DetailALBERTSON'S LLCOSCO DRUG #3964 9595 E BROADWAY BLVD
TUCSONAZ8574807/20/201810/01/2018 07/25/202207/27/2023
Contract DetailALBERTSON'S LLCALBERTSON'S PHARMACY #3203 1350 N. SILVERBELL RD
TUCSONAZ8574507/20/201810/01/2018  10/01/2018
Contract DetailALBERTSON'S LLCOSCO DRUG #959 6363 EAST 22ND STREET
TUCSONAZ8571007/20/201810/01/2018 04/11/201904/12/2019
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09211 6488 N. ORACLE ROAD
TUCSONAZ8570410/15/201501/01/2016  04/28/2017
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09232 4748 E. SUNRISE DRIVE
TUCSONAZ8571810/15/201501/01/2016 07/26/202410/21/2024
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09254 240 W CONTINENTAL RD
GREEN VALLEYAZ8562210/15/201501/01/2016  04/28/2017
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09273 3785 WEST INA RD.
TUCSONAZ8574110/15/201501/01/2016  04/28/2017
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09277 6895 E. SUNRISE
TUCSONAZ8575001/16/201904/01/2019  04/01/2019
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09274 615 N. ALVERNON
TUCSONAZ8571101/16/201904/01/2019  04/01/2019
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09274 615 N. ALVERNON
TUCSONAZ8571101/16/201904/01/2019 01/16/201901/21/2019
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09374 1900 W. VALENCIA RD.
TUCSONAZ8574601/16/201904/01/2019  04/01/2019
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09302 8920 E TANQUE VERDE
TUCSONAZ8574901/16/201904/01/2019  04/01/2019
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 08828 2090 EAST FRY BLVD.
SIERRA VISTAAZ8563501/16/201904/01/2019  04/01/2019
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09336 7901 E. GOLF LINKS ROAD
TUCSONAZ8573001/16/201904/01/2019  04/01/2019
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09272 7499 E. BROADWAY
TUCSONAZ8571001/16/201904/01/2019  04/01/2019
Contract DetailARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09207 865 E. GRANT
TUCSONAZ8571904/12/201907/01/2019 06/23/202204/13/2023
Contract DetailAVELLA OF DEER VALLEY23620 N 20TH DR #12
PHOENIXAZ85085-062107/28/201610/01/2016 09/10/202112/31/2021
Contract DetailAVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508507/28/201610/01/2016 07/16/202003/01/2022
Contract DetailAVELLA OF PHOENIX III1101 N CENTRAL AVE., STE. 102
PHOENIXAZ8500407/20/201810/01/2018 07/16/202003/01/2022
Contract DetailAVELLA OF SACRAMENTO, INC.2288 AUBURN BLVD #102
SACRAMENTOCA9582107/20/201810/01/2018 07/01/202003/01/2022
Contract DetailAVELLA OF TUCSON4512 E CAMP LOWELL DR
TUCSONAZ85712-128203/11/201304/01/2013 01/26/201805/22/2018
Contract DetailBANNER - UNIVERSITY MEDICAL CENTER SOUTH2800 E AJO WAY
TUCSONAZ85713-620404/14/201607/01/2016 12/31/202112/31/2021
Contract DetailBANNER FAMILY PHARMACY - TUCSON NORTH CA3838 N CAMPBELL AVE STE 2112
TUCSONAZ8571901/14/202201/28/2022  01/28/2022
Contract DetailBANNER FAMILY PHARMACY - UNIVERSITY MED1625 N CAMPBELL AVE
TUCSONAZ8571901/05/201601/07/2016  04/28/2017
Contract DetailBANNER FAMILY PHARMACY - UNIVERSITY MED2800 E AJO WAY
TUCSONAZ8571310/13/202101/01/2022  01/01/2022
Contract DetailBANNER FAMILY PHARMACY-CHANDLER7300 W DETROIT ST
CHANDLERAZ85226-241007/15/201510/01/2015  04/28/2017
Contract DetailBRIOVARX OF MAINE INCDBA BRIOVARX 53 DARLING AVE
SOUTH PORTLANDME0410604/17/201907/01/2019 07/01/202003/01/2022
Contract DetailBRIOVARX OF MASSACHUSETTS, LLCD/B/A BRIOVARX BLDG 2 - UNIT A
145 BODWELL STREET 		AVONMA0232204/17/201907/01/2019 07/01/202003/01/2022
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/17/201804/01/2018  01/17/2018
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/17/201804/01/2018  01/17/2018
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/17/201804/01/2018  01/17/2018
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/17/201804/01/2018  01/17/2018
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/17/201804/01/2018  01/17/2018
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/17/201804/01/2018  01/17/2018
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/17/201804/01/2018  01/17/2018
Contract DetailCAREMARK PUERTO RICO SPECIALTY PHARMACY,CAREMARK PUERTO RICO SPECIALTY PHARMACY 6020 AVE ROBERTO SANCHEZ VILELLA
CAROLINAPR0098207/16/202010/01/2020 04/01/202204/13/2023
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/17/201804/01/2018  01/17/2018
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/17/201804/01/2018  01/17/2018
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/16/202010/01/2020  10/01/2020
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 4310 EAST COTTON CENTER BLVD
SUITE 110 		PHOENIXAZ85040-885701/17/201804/01/2018 01/22/202203/01/2022
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 12450 EAST ARAPAHOE ROAD
SUITE A1 		CENTENNIALCO8011201/17/201804/01/2018 01/22/202203/01/2022
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 7400 WASHINGTON STREET NE
ALBUQUERQUENM8710901/17/201804/01/2018 01/22/202203/01/2022
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 6375 EAST TANQUE VERDE ROAD
SUITE 50 		TUCSONAZ85715-383701/17/201804/01/2018 01/22/202203/01/2022
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 3817 CONSTITUTION DRIVE
SUITE 300 		EL PASOTX79922-136701/17/201804/01/2018 01/22/202203/01/2022
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870601/15/202104/01/2021  04/01/2021
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/15/202104/01/2021  04/01/2021
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/16/202010/01/2020  10/01/2020
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503304/17/201907/01/2019  07/01/2019
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268307/16/202010/01/2020 01/24/202203/01/2022
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/11/201910/01/2019  10/01/2019
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/11/201910/01/2019  10/01/2019
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/11/201910/01/2019  10/01/2019
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/11/201910/01/2019  10/01/2019
Contract DetailGENOA HEALTHCARE LLC1101 NORTH CENTRAL AVE STE 102
PHOENIXAZ8500401/14/202201/24/2022 10/01/202301/24/2025
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07859 6370 N. CAMPBELL AVE., #120
TUCSONAZ8571810/15/201501/01/2016  04/28/2017
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 08420 7740 N CORTARO RD
TUCSONAZ8574310/15/201501/01/2016  04/28/2017
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY # 10006 10650 NORTH ORACLE RD
ORO VALLEYAZ8573710/15/201501/01/2016  04/28/2017
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07855 2601 S. HOUGHTON RD.
TUCSONAZ8573001/16/201904/01/2019  04/01/2019
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07867 5100 E. GRANT RD.
TUCSONAZ8571201/16/201904/01/2019  04/01/2019
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00086 1686 E FLORENCE BLVD
CASA GRANDEAZ8512201/16/201904/01/2019  04/01/2019
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07841 4365 N ORACLE RD
TUCSONAZ8570501/16/201904/01/2019  04/01/2019
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY # 10307 6310 E. BROADWAY BLVD.
TUCSONAZ8571001/16/201904/01/2019  04/01/2019
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY # 10184 825 EAST UNIVERSITY BLVD., SUITE 101
TUCSONAZ8571901/16/201904/01/2019  04/01/2019
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07876 3832 EAST SPEEDWAY
TUCSONAZ8571601/16/201904/01/2019  04/01/2019
Contract DetailGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00091 8705 E SPEEDWAY BLVD
TUCSONAZ8571007/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16296 6500 E GRANT RD
TUCSONAZ8571507/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16659 1225 W IRVINGTON RD
TUCSONAZ8571407/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS/PHARMACY #10742 2385 N. SILVERBELL ROAD
TUCSONAZ8574507/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16983 9615 E OLD SPANISH TRL
TUCSONAZ8574807/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16220 4151 E HIGHWAY 90
SIERRA VISTAAZ8563507/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17223 4040 N ORACLE RD
TUCSONAZ8570507/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16295 3901 W INA RD
TUCSONAZ8574107/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16217 10555 N ORACLE RD
ORO VALLEYAZ8573707/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16772 3699 E BROADWAY BLVD
TUCSONAZ8571607/16/202010/01/2020 10/01/202007/14/2021
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16772 3699 E BROADWAY BLVD
TUCSONAZ8571604/13/202307/01/2023  07/01/2023
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16296 6500 E GRANT RD
TUCSONAZ8571504/13/202307/01/2023  07/01/2023
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS/PHARMACY #10742 2385 N. SILVERBELL ROAD
TUCSONAZ8574504/13/202307/01/2023  07/01/2023
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16217 10555 N ORACLE RD
ORO VALLEYAZ8573707/14/202310/01/2023  10/01/2023
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17223 4040 N ORACLE RD
TUCSONAZ8570507/14/202310/01/2023  10/01/2023
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16983 9615 E OLD SPANISH TRL
TUCSONAZ8574807/14/202310/01/2023  10/01/2023
Contract DetailGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16659 1225 W IRVINGTON RD
TUCSONAZ8571407/14/202310/01/2023  10/01/2023
Contract DetailKMART PHARMACY #4996  7055 EAST BROADWAY
TUCSONAZ8571010/13/201701/01/2018 01/19/201801/22/2018
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191304/17/201907/01/2019  07/01/2019
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260101/11/202404/01/2024  04/01/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/13/202307/01/2023  07/01/2023
Contract DetailOPTUM INFUSION SERVICES 305, LLC4000 CHEMICAL RD STE 100
PLYMOUTH MEETINGPA1946204/13/202307/01/2023  07/01/2023
Contract DetailOPTUM INFUSION SERVICES 308, LLC485 N JUNIPER DR STE 2
CHANDLERAZ8522604/13/202307/01/2023  07/01/2023
Contract DetailOPTUM INFUSION SERVICES 550, LLC1819 ASTON AVE STE 104
CARLSBADCA9200804/13/202307/01/2023  07/01/2023
Contract DetailOPTUM INFUSION SERVICES 550, LLC7167 E. KEMPER RD.
CINCINNATIOH4524904/13/202307/01/2023  07/01/2023
Contract DetailOPTUM INFUSION SERVICES 553, LLC6531 MERIDIEN DR SUITE 113
RALEIGHNC2761604/13/202307/01/2023  07/01/2023
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502901/14/202204/01/2022 10/01/202301/11/2024
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/14/202201/24/2022  01/24/2022
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/17/201907/01/2019  07/01/2019
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824901/14/202204/01/2022 10/01/202301/11/2024
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/17/201907/01/2019  07/01/2019
Contract DetailOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970507/16/202010/01/2020  10/01/2020
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110104/17/201907/01/2019 07/01/202003/01/2022
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140107/16/202010/01/2020  10/01/2020
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/16/202007/16/2020  07/22/2020
Contract DetailOPTUM PHARMACY 805, INC1101 N CENTRAL AVE, STE 102
PHOENIXAZ85004-182907/16/202007/16/2020 01/24/202203/01/2022
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/16/202010/01/2020 10/01/202301/11/2024
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660807/16/202010/01/2020 05/27/202204/13/2023
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999204/17/201907/01/2019 11/09/202204/13/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/17/201804/01/2018  01/17/2018
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681307/16/202010/01/2020  10/01/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/16/202010/01/2020  10/01/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/16/202010/01/2020  10/01/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #3129 1002 EAST MCDOWELL ROAD
PHOENIXAZ8500607/16/202010/01/2020 10/01/202007/14/2021
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #2044 260 W CONTINENTAL RD
GREEN VALLEYAZ85622-355507/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1749 9100 N SILVERBELL RD
TUCSONAZ8574307/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #2648 2125 N HIGHWAY 70
THATCHERAZ8555207/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1275 599 WEST 4TH STREET
BENSONAZ8560207/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1983 2140 W. GRANT ROAD
TUCSONAZ85745-114207/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1989 9460 E. GOLF LINKS ROAD
TUCSONAZ85730-133707/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1255 7110 N ORACLE RD.
TUCSONAZ8570407/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #0255 1551 W ST MARYS RD
TUCSONAZ8574507/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1684 1940 E BROADWAY BLVD
TUCSONAZ8571907/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #0272 650 N BISBEE AVENUE
WILLCOXAZ8564307/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #0267 2940 W. VALENCIA ROAD
TUCSONAZ8574607/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1771 1305 W. DUVAL MINE ROAD
GREEN VALLEYAZ8561407/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1986 9050 E. VALENCIA ROAD
TUCSONAZ85747-490007/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1874 6360 E. GOLF LINKS RD
TUCSONAZ8573007/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1732 1449 N. ARIZONA BLVD
COOLIDGEAZ85128-321407/20/201810/01/2018 07/15/202201/24/2025
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #3322 10380 EAST BROADWAY BLVD
TUCSONAZ8574807/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #0261 101 NACO HIGHWAY
BOX 101 		BISBEEAZ8560307/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1521 12122 N. RANCHO VISTOSO BLVD.
ORO VALLEYAZ8575507/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1733 900 W. DEUCE OF CLUBS
SHOW LOWAZ8590107/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1988 7177 E. TANQUE VERDE
TUCSONAZ85715-343107/20/201810/01/2018 07/25/202207/27/2023
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104204/15/202407/01/2024  07/01/2024
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022304/15/202407/01/2024  07/01/2024
Contract DetailSMITH'S FOOD & DRUGDBA FRY'S FOOD & DRUG #17 4150 E. 22ND STREET
TUCSONAZ8571104/12/201307/01/2013 01/22/202501/24/2025
Contract DetailSMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD AND DRUG #131 2480 NORTH SWAN ROAD
TUCSONAZ8571204/12/201307/01/2013 01/22/202501/24/2025
Contract DetailSMITH'S FOOD & DRUG CTRS INC  DBA FRY'S FOOD AND DRUG #119
902 W IRVINGTON 		TUCSONAZ8571404/12/201307/01/2013 02/24/201704/28/2017
Contract DetailSMITHS FOOD & DRUG CENTERDBA FRYS FOOD & DRUG #20 3640 S 16 AVENUE
TUCSONAZ8571304/12/201307/01/2013 01/22/202501/24/2025
Contract DetailSMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #34 7812 E. SPEEDWAY
TUCSONAZ8571004/12/201307/01/2013 01/22/202501/24/2025
Contract DetailSMITHS FOOD & DRUG CENTERSDBA FRY?S PHARMACY #019 3920 E GRANT ROAD
TUCSONAZ8571204/12/201307/01/2013 02/02/201805/22/2018
Contract DetailSMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #42 9401 E 22 STREET
TUCSONAZ8571004/12/201307/01/2013 01/22/202501/24/2025
Contract DetailSMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #21 555 E GRANT ROAD
TUCSONAZ8570504/12/201307/01/2013 01/22/202501/24/2025
Contract DetailSMITHS FOOD & DRUG CENTERSDBA FRYS PHARMACY #36 3770 W INA ROAD
TUCSONAZ8574104/12/201307/01/2013 01/22/202501/24/2025
Contract DetailSMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #58 2001 E IRVINGTON ROAD
TUCSONAZ8571404/12/201307/01/2013 01/22/202501/24/2025
Contract DetailSMITHS FOOD DRUG CTRS. INCDBA FRYS FOOD DRUG #90 8080 S. HOUGHTON RD
TUCSONAZ85747-979104/12/201307/01/2013 01/22/202501/24/2025
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/14/202204/01/2022 07/11/202307/14/2023
Contract DetailWAL-MART PHARMACY 10-16121650 WEST VALENCIA
TUCSONAZ8574602/28/201304/01/2013 07/11/202307/14/2023
Contract DetailWAL-MART PHARMACY 10-33772823 WEST VALENCIA ROAD
TUSCON (CARDINAL)AZ8574602/26/201304/01/2013 07/11/202307/14/2023
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/14/202204/01/2022 07/11/202307/14/2023
Contract DetailWALGREEN ARIZONA DRUG CODBA:WALGREENS #15363 4655 E. SUNRISE DR.
TUCSONAZ8571801/18/201604/01/2016  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05532 2929 W VALENCIA ROAD
TUCSONAZ8574603/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03837 1550 W VALENCIA
TUCSONAZ8574603/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05209 3180 N CAMPBELL AVE
TUCSONAZ8571903/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03249 4910 NORTH FIRST AVE
TUCSONAZ8571803/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06766 1880 E IRVINGTON ROAD
TUCSONAZ85714-175403/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05312 375 W CONTINENTAL RD
GREEN VALLEYAZ8562203/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS #15030 730 E GRANT ROAD
TUCSONAZ8571903/09/201104/01/2011 01/01/202101/15/2021
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05892 3910 E 22ND STREET
TUCSONAZ8571103/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04045 4685 E GRANT RD
TUCSONAZ8571203/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03377 1900 S 6TH AVE
TUCSONAZ8571303/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06571 2180 W GRANT ROAD
TUCSONAZ85745-114203/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 09186 18600 S NOGALES HWY
GREEN VALLEYAZ8561403/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 11183 3200 E SPEEDWAY
TUCSONAZ8571603/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 10879 7111 E. GOLF LINKS RD.
TUCSONAZ8573003/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06953 605 W AJO WAY
TUCSONAZ85713-604703/09/201104/01/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA WALGREENS SPECIALTY PHARMACY #21393 3627 N CAMPBELL AVE
TUCSONAZ8571910/12/201110/12/2011  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 01899 9495 EAST SPEEDWAY BLVD
TUCSONAZ8571007/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS #15502 8980 E TANQUE VERDE ROAD
TUCSONAZ8574907/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02232 313 W ESPERANZA BLVD
GREEN VALLEYAZ8561407/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02372 7114 NORTH ORACLE
TUCSONAZ8570407/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02451 4220 N ORACLE RD
TUCSONAZ85705-163207/12/201310/01/2013 11/09/202207/27/2023
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02910 8730 E BROADWAY BLVD
TUCSONAZ8571007/12/201310/01/2013 02/28/202407/10/2024
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03007 9470 E GOLF LINKS RD
TUCSONAZ8573007/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03097 7115 E.TANQUE VERDE
TUCSONAZ8571507/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03447 12965 N ORACLE RD
TUCSONAZ8573907/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03463 1415 W RIVER RD
TUCSONAZ8570407/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03630 9220 N. THORNYDALE RD
TUCSONAZ8574207/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03856 5480 E 22ND STREET
TUCSONAZ85711-540607/12/201310/01/2013 01/01/202101/15/2021
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04102 6767 E. BROADWAY BLVD.
TUCSONAZ8571007/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04103 10405 N. LA CANADA DR.
ORO VALLEYAZ8573707/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04104 2411 N. ORACLE ROAD
TUCSONAZ8570507/12/201310/01/2013 02/08/201604/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04266 2150 W ORANGE GROVE RD
TUCSONAZ8574107/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04764 5455 E SPEEDWAY BLVD
TUCSONAZ8571207/12/201310/01/2013 02/28/202407/10/2024
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05156 7800 N. CORTARO RD.
TUCSONAZ8574307/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05750 10315 E BROADWAY BLVD
TUCSONAZ85748-340907/12/201310/01/2013 01/01/202101/15/2021
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06244 4700 E BROADWAY BLVD
TUCSONAZ8571107/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06245 7877 E SNYDER RD
TUCSONAZ8575007/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06411 11951 N 1ST AVE
ORO VALLEYAZ85737-878707/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06491 1351 W PRINCE ROAD
TUCSONAZ8570507/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06645 5525 E RIVER RD
TUCSONAZ85750-194907/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07041 9184 E VALENCIA ROAD
TUCSONAZ85747-490207/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07104 1145 S HARRISON ROAD
TUCSONAZ85748-664007/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07203 2415 N ALVERNON WAY
TUCSONAZ85712-250107/12/201310/01/2013 02/08/201604/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07209 3800 W INA RD
TUCSONAZ8574107/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07232 9250 N COACHLINE BLVD
TUCSONAZ8574307/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07304 2175 W INA ROAD
TUCSONAZ85741-264807/12/201310/01/2013 11/09/202207/27/2023
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07463 525 W VALENCIA ROAD
TUCSONAZ85706-763607/12/201310/01/2013 11/07/202401/24/2025
Contract DetailWALGREEN ARIZONA DRUG CO.DBA; WALGREENS #09952 12050 N DOVE MOUNTAIN BLVD
MARANAAZ85658-421107/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 09953 7885 E SPEEDWAY BLVD
TUCSONAZ85710-162607/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS #10684 13542 E COLOSSAL CAVE RD
VAILAZ8564107/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 13822 550 N. SILVERBELL RD
TUCSONAZ85745-310707/12/201310/01/2013  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07623 1959 N GRAND AVE
NOGALESAZ85621-134101/18/201604/01/2016  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05027 1950 E FRY BLVD
SIERRA VISTAAZ8563501/18/201604/01/2016  04/28/2017
Contract DetailWALGREEN ARIZONA DRUG CO.WALGREENS CENTRAL FILL #21372 120 N 83RD AVE
STE 200 		TOLLESONAZ8535310/13/202101/01/2022  01/01/2022
Contract DetailWALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528407/12/201310/01/2013 12/08/201504/28/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/17/201907/01/2019 10/01/202104/13/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/17/201907/01/2019  07/01/2019
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/17/201907/01/2019  07/01/2019
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/17/201907/01/2019  07/01/2019
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH030064AChildDSHBanner - University Medical Center TucsonBanner - UNIVERSITY HEALTH CARE-PANTANO7901 EAST 22ND STREETTUCSONAZTerminated
DSH030064AAChildDSHBanner - University Medical Center TucsonNorth Hills - PBC UC-NH Orthopedics-clinic265 West Ina RoadTucsonAZActive
DSH030064ABChildDSHBanner - University Medical Center TucsonNorth Hills - PBC UC-NH Internal Med Clinic265 West Ina RoadTucsonAZTerminated
DSH030064ACChildDSHBanner - University Medical Center TucsonGreen Valley - PBC UC- GV Nephrology-Clinic1141 S. LA CANADA DR.GREEN VALLEYAZTerminated
DSH030064ADChildDSHBanner - University Medical Center TucsonGreen Valley - PBC UC- GV Internal Med Clinic1141 S. LA CANADA DR.Green ValleyAZTerminated
DSH030064AEChildDSHBanner - University Medical Center TucsonGreen Valley - PBC UC- GV Podiatry-clinic1141 S. LA CANADA DR.GREEN VALLEYAZTerminated
DSH030064AFChildDSHBanner - University Medical Center TucsonGreen Valley - PBC UC- GV Urology-Clinic1141 S. LA CANADA DR.GREEN VALLEYAZTerminated
DSH030064AGChildDSHBanner - University Medical Center TucsonGreen Valley - PBC UC- GV Cardiology-clinic1141 S. LA CANADA DR.Green ValleyAZTerminated
DSH030064AHChildDSHBanner - University Medical Center TucsonGreen Valley - PBC UC - GV Gynecology Clinic1141 S. LA CANADA DR.Green ValleyAZTerminated
DSH030064AJChildDSHBanner - University Medical Center TucsonGreen Valley - PBC UC GV Otolaryngology-Clin1141 S. LA CANADA DR.GREEN VALLEYAZTerminated
DSH030064AKChildDSHBanner - University Medical Center TucsonAlvernon - Alvernon Orthopedics-Clinic707 North Alvernon WayTucsonAZActive
DSH030064ALChildDSHBanner - University Medical Center TucsonPantano - PBC UC-PAN Pediatrics Clinic7901 East 22nd StreetTucsonAZTerminated
DSH030064AMChildDSHBanner - University Medical Center TucsonPantano - PBC-Pan Geriatrics-clinic7901 East 22nd StreetTucsonAZTerminated
DSH030064ANChildDSHBanner - University Medical Center TucsonPantano - Pantano Clinic7901 East 22nd StreetTucsonAZTerminated
DSH030064APChildDSHBanner - University Medical Center TucsonPantano - PBC UC-PAN Internal Med-Clinic7901 East 22nd StreetTucsonAZTerminated
DSH030064AQChildDSHBanner - University Medical Center TucsonPantano - PBC UC-Pan Gynecology-clinic7901 East 22nd StreetTucsonAZTerminated
DSH030064ARChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-CardioThoracic-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064ASChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-NC Urology-Clinic3838 N. Campbell AvenueTucsonAZActive
DSH030064ATChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Vascular-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064AUChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-NC Support Care-Clinic3838 N. Campbell AvenueTucsonAZTerminated
DSH030064AVChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Neurosurgery-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064AWChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Int Med/Geriatrics-Clin-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064AXChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Nephrology-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064AYChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Endo-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064AZChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Neurology Gen-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BChildDSHBanner - University Medical Center TucsonBanner - UNIVERSITY HEALTH CARE-NORTH HILLS265 WEST INA ROADTUCSONAZActive
DSH030064BAChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-ENT-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BBChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Infect Disease-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BCChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Diagnostic Cardiol-Clin-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BDChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Pacemaker-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BEChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Gastroenterology-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BFChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Pulmonary Fnct Test-Cli-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BGChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Rheumatology-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BHChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Podiatry-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BJChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Radiation Oncology-Clin-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BKChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Primary Care-Clinic3838 N. Campbell AvenueTucsonAZTerminated
DSH030064BLChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-OB/GYN-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BMChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Ambdom Transplant-Clin-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BNChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Trauma/Burn-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BPChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Sleep-Clinic-NC3838 N. Campbell AvenueTucsonAZTerminated
DSH030064BQChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Allergy-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BRChildDSHBanner - University Medical Center TucsonClinic F Multispecialty3838 N. Campbell AvenueTucsonAZActive
DSH030064BSChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - Surg OP-20PC-Clinic3838 N. Campbell AvenueTucsonAZTerminated
DSH030064BTChildDSHBanner - University Medical Center TucsonClinic H Multispecialty3838 N. Campbell AvenueTucsonAZActive
DSH030064BUChildDSHBanner - University Medical Center TucsonNorth Campus 2 BUMN - C/P-Cardiology-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064BVChildDSHBanner - University Medical Center TucsonCancer Center - Medication Mgmt Clinic-Hosp3838 North Campbell AveTucsonAZTerminated
DSH030064BWChildDSHBanner - University Medical Center TucsonCancer Center - Medication Mgmt Clinic3838 North Campbell AveTucsonAZActive
DSH030064BXChildDSHBanner - University Medical Center TucsonC/P-NC Hemonc - Clinic - Hematology / Oncology3838 N. Campbell Avenue,TucsonAZActive
DSH030064BYChildDSHBanner - University Medical Center TucsonPBC UC-NH Pediatrics - Clinic - Pediatrics265 West Ina RoadTucsonAZActive
DSH030064BZChildDSHBanner - University Medical Center TucsonC/P-Imaging-Clinic-NC3838 N. Campbell AvenueTucsonAZActive
DSH030064CAChildDSHBanner - University Medical Center TucsonENT Audiology-Clinic-NC - Audiology3838 N. Campbell AvenueTucsonAZActive
DSH030064CBChildDSHBanner - University Medical Center TucsonPBC UC-GV Gen Surg - Clinic - General Surgery1141 S. La Canada DrGreen ValleyAZTerminated
DSH030064CCChildDSHBanner - University Medical Center TucsonPBC UG-GV Vascular Surg Clinic - Vascular Surgery1141 S. La Canada DrGreen ValleyAZTerminated
DSH030064CDChildDSHBanner - University Medical Center TucsonBANNER UNIVERSITY MED CENTER TUCSON - Psych-Clinic-NC3838 N Campbell AveTucsonAZTerminated
DSH030064CEChildDSHBanner - University Medical Center TucsonBANNER UNIVERSITY MED CENTER TUCSON - Cancer Genetics Counsel-Hosp3838 N Campbell AveTucsonAZActive
DSH030064CFChildDSHBanner - University Medical Center TucsonBANNER - UNIVERSITY MEDICAL CENTER - Pantano Clinic7901 E 22ND STTUCSONAZActive
DSH030064CGChildDSHBanner - University Medical Center TucsonBANNER - UNIVERSITY MEDICAL CENTER - Green Valley Clinic-Clinic1141 S LA CANADA DRGREEN VALLEYAZActive
DSH030064CHChildDSHBanner - University Medical Center TucsonNORTH HILLS - PBC-UC Pain Mgmt-Clinic1891 WEST ORANGE GROVE ROADTucsonAZActive
DSH030064CJChildDSHBanner - University Medical Center TucsonCLINIC - Plastics Surg-Clinic-NC3838 NORTH CAMPBELL AVE, BUILDING 2, CLINIC H, 3RD FLOORTucsonAZActive
DSH030064HChildDSHBanner - University Medical Center TucsonOutpatient Infusion-Hosp3838 North Campbell AvenueTucsonAZActive
DSH030064IChildDSHBanner - University Medical Center TucsonC/P-OG Hemeonc-Clinic1891 W. ORANGE GROVE RDTUCSONAZActive
DSH030064JChildDSHBanner - University Medical Center TucsonPBC UC-GV Primary Care-Clinic1141 S. LA CANADA DR.GREEN VALLEYAZTerminated
DSH030064KChildDSHBanner - University Medical Center TucsonBanner - UMC Alvernon Surgery Center750 North Alvernon WayTucsonAZTerminated
DSH030064LChildDSHBanner - University Medical Center TucsonBanner - UMC Alvernon707 North Alvernon WayTucsonAZTerminated
DSH030064MChildDSHBanner - University Medical Center TucsonBanner - UMC La Cholla Clinic6261 North La ChollaTucsonAZTerminated
DSH030064NChildDSHBanner - University Medical Center TucsonBanner - University Medical Imaging (UMI)4291 N. Campbell AvenueTucsonAZTerminated
DSH030064PChildDSHBanner - University Medical Center TucsonBanner - AZCC - Urology3838 N. Campbell AvenueTucsonAZTerminated
DSH030064QChildDSHBanner - University Medical Center TucsonC/P-Mohs Dermatology Clinic3838 N. Campbell AvenueTucsonAZActive
DSH030064RChildDSHBanner - University Medical Center TucsonBanner - AZCC - Radiation Oncology at Orange Grove1891 W. Orange Grove RdTucsonAZTerminated
DSH030064SChildDSHBanner - University Medical Center TucsonBanner - AZCC - Bone Marrow Transplant Adult3838 N. Campbell AvenueTucsonAZTerminated
DSH030064TChildDSHBanner - University Medical Center TucsonBanner - AZCC - North Campus Clinic3838 N. Campbell AvenueTucsonAZTerminated
DSH030064UChildDSHBanner - University Medical Center TucsonBanner - AZCC Bone Marrow Transplant (BMT)1625 North Campbell AvenueTucsonAZTerminated
DSH030064VChildDSHBanner - University Medical Center TucsonBanner - Arizona Cancer Center - Lab - North Campus3838 North Campbell AvenueTucsonAZTerminated
DSH030064WChildDSHBanner - University Medical Center TucsonSurgery 6OPC3838 N Campbell AveTucsonAZTerminated
DSH030064XChildDSHBanner - University Medical Center TucsonSurgery 5OPC3838 N Campbell AveTucsonAZTerminated
DSH030064YChildDSHBanner - University Medical Center TucsonSurgery 4OPC3838 N Campbell AveTucsonAZTerminated
DSH030064ZChildDSHBanner - University Medical Center TucsonMedicine 2OPC3838 N Campbell AveTucsonAZTerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressUpdateChange RequestBanner - University Medical Center Tucson 1501 N Campbell Ave Attn: CAR-T Tucson, AZ 85724Banner - University Medical Center Tucson 1501 N Campbell Ave Rm 0325 Attn: CAR-T Tucson, AZ 857241/29/2025 8:06 AM
ContactsAuthorizing OfficialUpdateAO Change RequestHipp, Brad Chief Financial Officer Banner University Medical Centers Tucson and South 5206943446Onken, Meiko Chief Operating Officer Banner Health 602625265110/16/2024 7:35 AM
DetailsLast Recertification DateUpdateRecertification8/25/2023 7:56:43 AM8/12/2024 10:48:28 AM8/12/2024 10:48 AM
DetailsLast Recertification DateUpdateRecertification9/12/2022 10:46:54 AM8/25/2023 7:56:43 AM8/25/2023 7:56 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False3/14/2023 6:23 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 0056383/14/2023 6:23 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request AZ3/14/2023 6:23 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 15088094273/14/2023 6:23 PM
Medicaid BillingNPI: StateInsertGroup Change Request AZ3/14/2023 6:23 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request020470-01 (AZ) 12/15/2022 8:54 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request9000142345 (CO) 12/15/2022 8:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1508809427 (AZ) 12/15/2022 8:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1649668450 (AZ) 12/15/2022 8:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1265820179 (CO) 12/15/2022 8:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1508809427 (CO) 12/15/2022 8:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1649668450 (CO) 12/15/2022 8:54 AM
AddressesShipping AddressInsertChange Request Banner - University Medical Center Tucson 1501 N Campbell Ave Attn: CAR-T Tucson, AZ 8572412/12/2022 8:20 AM
AddressesShipping AddressInsertChange Request Banner University Medical Center - Tucson 1625 N Campbell Ave Tucson, AZ 8571912/12/2022 8:20 AM
AddressesShipping AddressInsertChange Request SafeCor Health 4060 Business Park Drive Columbus, OH 43204-504612/12/2022 8:20 AM
DetailsLast Recertification DateUpdateRecertification9/9/2021 5:31:14 PM9/12/2022 10:46:54 AM9/12/2022 10:46 AM
AddressesShipping AddressDeleteRecertificationBanner University Medical Center Tucson 1625 NORTH CAMPBELL AVENUE (Drachman & Warren Ave) Tucson, AZ 85719 9/9/2021 5:31 PM
AddressesShipping AddressDeleteRecertificationBanner Health 7300 W. Detroit St. Chandler, AZ 85226 9/9/2021 5:31 PM
DetailsLast Recertification DateUpdateRecertification9/8/2020 1:26:20 PM9/9/2021 5:31:14 PM9/9/2021 5:31 PM
AddressesBilling AddressUpdateChange RequestBanner - University Medical Center Tucson 1625 North Campbell Avenue Tucson, AZ 85719Banner Health Accounts Payable PO Box 2977 Phoenix, AZ 850626/14/2021 10:45 PM
Medicaid BillingMedicaid: NumberDeleteChange Request100542115 (NV) 6/14/2021 10:45 PM
Medicaid BillingMedicaid: NumberDeleteChange Request10026590500 (NE) 6/14/2021 10:45 PM
Medicaid BillingMedicaid: NumberDeleteChange Request145728400 (WY) 6/14/2021 10:45 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (NE) 6/14/2021 10:45 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (NE) 6/14/2021 10:45 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (NE) 6/14/2021 10:45 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (WY) 6/14/2021 10:45 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (WY) 6/14/2021 10:45 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (WY) 6/14/2021 10:45 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (NV) 6/14/2021 10:45 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (NV) 6/14/2021 10:45 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (NV) 6/14/2021 10:45 PM
Medicaid BillingMedicaid: NumberDeleteChange Request425805300 (MD) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1265820179 (MI) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request200784450A (OK) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request7100564160 (KY) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request500707030 (OR) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request395387902 (TX) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request0635921 (MT) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request395387901 (TX) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1657501 (AK) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1265820179 (CT) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request003189644A (GA) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1265820179 (IA) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1265820179 (ID) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request2432435 (LA) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1265820179 (MN) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request00096009 (MS) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1265820179 (NC) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request19852088 (NM) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1031106620001 (PA) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request11566A (SC) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange RequestQ028631 (TN) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1265820179 (UT) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request2017276884 (VA) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request2060663 (WA) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request100063007 (WI) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: NumberDeleteChange Request0596345 (NJ) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (MT) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (MT) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (MT) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (TX) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (TX) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (TX) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (MS) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (MS) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (MS) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (GA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (GA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (GA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (NJ) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (NJ) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (NJ) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (WI) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (WI) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (WI) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (PA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (PA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (PA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (SC) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (SC) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (SC) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (CT) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (CT) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (CT) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (IA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (IA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (IA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (ID) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (ID) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (ID) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (MN) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (MN) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (MN) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (NC) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (NC) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (NC) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (UT) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (UT) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (UT) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (MI) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (MI) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (MI) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (AK) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (AK) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (AK) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (NM) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (NM) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (NM) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (OK) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (OK) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (OK) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (VA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (VA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (VA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (WA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (WA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (WA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (LA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (LA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (LA) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (MD) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (MD) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (MD) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (OR) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (OR) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (OR) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (KY) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (KY) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (KY) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1265820179 (TN) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1508809427 (TN) 1/28/2021 5:05 PM
Medicaid BillingNPI: NumberDeleteChange Request1649668450 (TN) 1/28/2021 5:05 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10054211512/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertChange Request NV12/10/2020 5:15 PM
Medicaid BillingNPI: NumberInsertChange Request 126582017912/10/2020 5:15 PM
Medicaid BillingNPI: StateInsertChange Request NV12/10/2020 5:15 PM
Medicaid BillingNPI: NumberInsertChange Request 150880942712/10/2020 5:15 PM
Medicaid BillingNPI: StateInsertChange Request NV12/10/2020 5:15 PM
Medicaid BillingNPI: NumberInsertChange Request 164966845012/10/2020 5:15 PM
Medicaid BillingNPI: StateInsertChange Request NV12/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 1:26 PM
Medicaid BillingMedicaid: NumberInsertRecertification 06359219/8/2020 1:26 PM
Medicaid BillingMedicaid: StateInsertRecertification MT9/8/2020 1:26 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 1:26 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3953879019/8/2020 1:26 PM
Medicaid BillingMedicaid: StateInsertRecertification TX9/8/2020 1:26 PM
Medicaid BillingNPI: NumberDeleteRecertification1265820179 ( ) 9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MT9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MT9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MT9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification TX9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification TX9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification TX9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MS9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MS9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MS9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification GA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification GA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification GA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NJ9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NJ9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NJ9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification WI9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification WI9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification WI9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NE9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NE9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NE9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification SC9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification SC9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification SC9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification CT9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification CT9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification CT9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification IA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification IA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification IA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification ID9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification ID9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification ID9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MN9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MN9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MN9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NC9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NC9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NC9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification UT9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification UT9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification UT9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MI9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MI9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MI9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification WY9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification WY9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification WY9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification AK9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification AK9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification AK9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NM9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NM9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification NM9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification OK9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification OK9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification OK9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification VA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification VA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification VA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification WA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification WA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification WA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification LA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification LA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification LA9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MD9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MD9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification MD9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification OR9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification OR9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification OR9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification KY9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification KY9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification KY9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification CO9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification CO9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification CO9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 12658201799/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification TN9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 15088094279/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification TN9/8/2020 1:26 PM
Medicaid BillingNPI: NumberInsertRecertification 16496684509/8/2020 1:26 PM
Medicaid BillingNPI: StateInsertRecertification TN9/8/2020 1:26 PM
Medicaid BillingNPI: NumberDeleteRecertification1649668450 ( ) 9/8/2020 1:26 PM
Medicaid BillingNPI: NumberDeleteRecertification1508809427 ( ) 9/8/2020 1:26 PM
DetailsLast Recertification DateUpdateRecertification9/5/2019 7:36:52 AM9/8/2020 1:26:20 PM9/8/2020 1:26 PM
AddressesShipping AddressInsertChange Request Banner Health 7300 W. Detroit St. Chandler, AZ 852262/3/2020 2:56 PM
DetailsLast Recertification DateUpdateRecertification8/30/2018 2:15:14 PM9/5/2019 7:36:52 AM9/5/2019 7:36 AM
ContactsAuthorizing OfficialUpdateChange RequestFrost, Sarah Chief Operating Officer Banner UMC South and Tucson campuses 5206943445Hipp, Brad Chief Financial Officer Banner University Medical Centers Tucson and South 52069434467/29/2019 3:24 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/21/2019 4:42 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5007070306/21/2019 4:42 PM
Medicaid BillingMedicaid: StateInsertChange Request OR6/21/2019 4:42 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/21/2019 4:42 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3953879026/21/2019 4:42 PM
Medicaid BillingMedicaid: StateInsertChange Request TX6/21/2019 4:42 PM
Medicaid BillingNPI: NumberDeleteChange Request1588614911 ( ) 6/21/2019 1:54 PM
AddressesShipping AddressDeleteChange RequestBanner University Medical Center Tucson 1501 N Campbell Ave (Drachman & Warren Ave) Tucson, AZ 85724 5/6/2019 7:43 AM
AddressesShipping AddressInsertChange Request Banner University Medical Center Tucson 1625 NORTH CAMPBELL AVENUE (Drachman & Warren Ave) Tucson, AZ 857195/6/2019 7:43 AM
AddressesMain AddressUpdateChange Request 1501 NORTH CAMPBELL AVENUE TUCSON, AZ 85724 1625 NORTH CAMPBELL AVENUE TUCSON, AZ 857195/6/2019 7:43 AM
AddressesBilling AddressUpdateChange RequestBanner - University Medical Center Tucson 1501 North Campbell Avenue Tucson, AZ 85724Banner - University Medical Center Tucson 1625 NORTH CAMPBELL AVENUE Tucson, AZ 857195/6/2019 7:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/16/2019 10:38 AM
Medicaid BillingMedicaid: NumberInsertChange Request 71005641601/16/2019 10:38 AM
Medicaid BillingMedicaid: StateInsertChange Request KY1/16/2019 10:38 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False11/29/2018 9:24 AM
Medicaid BillingMedicaid: NumberInsertChange Request 42580530011/29/2018 9:24 AM
Medicaid BillingMedicaid: StateInsertChange Request MD11/29/2018 9:24 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False11/29/2018 9:24 AM
Medicaid BillingMedicaid: NumberInsertChange Request 126582017911/29/2018 9:24 AM
Medicaid BillingMedicaid: StateInsertChange Request MI11/29/2018 9:24 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False11/29/2018 9:24 AM
Medicaid BillingMedicaid: NumberInsertChange Request 200784450A11/29/2018 9:24 AM
Medicaid BillingMedicaid: StateInsertChange Request OK11/29/2018 9:24 AM
ContactsAuthorizing OfficialUpdateChange RequestPolashek, Maurene Sr Dir Finance Banner University Medical Centers Tucson/South 5206943446Frost, Sarah Chief Operating Officer Banner UMC South and Tucson campuses 52069434459/27/2018 7:35 AM
DetailsLast Recertification DateUpdateRecertification12/5/2017 8:15:07 AM8/30/2018 2:15:14 PM8/30/2018 2:15 PM
AddressesShipping AddressInsertChange Request Banner University Medical Center Tucson 1501 N Campbell Ave (Drachman & Warren Ave) Tucson, AZ 857247/27/2018 11:01 AM
AddressesShipping AddressDeleteChange RequestBanner - UNIVERSITY MEDICAL CENTER DRACHMAN & WARREN AVE TUCSON, AZ 85724 7/27/2018 11:01 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/27/2018 11:01 AM
Medicaid BillingMedicaid: NumberInsertChange Request 05963457/27/2018 11:01 AM
Medicaid BillingMedicaid: StateInsertChange Request NJ7/27/2018 11:01 AM
Medicaid BillingNPI: NumberDeleteChange Request1154384899 ( ) 7/27/2018 11:01 AM
Medicaid BillingNPI: NumberDeleteChange Request1306908355 ( ) 7/27/2018 11:01 AM
Medicaid BillingNPI: NumberDeleteChange Request1275921082 ( ) 7/27/2018 11:01 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 16575013/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request AK3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 90001423453/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request CO3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 12658201793/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request CT3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003189644A3/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request GA3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 12658201793/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request IA3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 12658201793/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request ID3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 24324353/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request LA3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 12658201793/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request MN3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 000960093/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request MS3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 12658201793/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request NC3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 100265905003/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request NE3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 198520883/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request NM3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10311066200013/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request PA3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 11566A3/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request SC3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request Q0286313/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request TN3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 12658201793/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request UT3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 20172768843/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request VA3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 20606633/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request WA3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1000630073/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request WI3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/16/2018 7:22 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1457284003/16/2018 7:22 PM
Medicaid BillingMedicaid: StateInsertChange Request WY3/16/2018 7:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False12/5/2017 8:15 AM
Medicaid BillingMedicaid: NumberInsertRecertification 98843912/5/2017 8:15 AM
Medicaid BillingMedicaid: StateInsertRecertification AZ12/5/2017 8:15 AM
Medicaid BillingNPI: NumberInsertRecertification 164966845012/5/2017 8:15 AM
Medicaid BillingNPI: NumberInsertRecertification 150880942712/5/2017 8:15 AM
DetailsLast Recertification DateUpdateRecertification9/2/2016 12:00:00 AM12/5/2017 8:15:07 AM12/5/2017 8:15 AM
ContactsPrimary ContactUpdate Weibel, Kurt Director of Pharmacy Services 5206946061Weibel, Kurt Director of Pharmacy Services Banner University Medical Center Tucson 520694606110/13/2017 4:14 PM
ContactsAuthorizing OfficialUpdateChange RequestPolashek, Maurene Sr Dir Finance 5206943446Polashek, Maurene Sr Dir Finance Banner University Medical Centers Tucson/South 520694344610/10/2017 3:53 PM
ContactsAuthorizing OfficialUpdate Mohesky, Debra CFO 6028393620Polashek, Maurene Sr Dir Finance 52069434466/23/2017 11:11 AM
AddressesMain AddressInsert   1501 NORTH CAMPBELL AVENUE TUCSON, AZ 857246/22/2017 10:57 AM
AddressesBilling AddressInsert  Banner - University Medical Center Tucson 1501 North Campbell Avenue Tucson, AZ 857246/22/2017 10:57 AM
AddressesShipping AddressInsert  Banner - UNIVERSITY MEDICAL CENTER DRACHMAN & WARREN AVE TUCSON, AZ 857246/22/2017 10:57 AM
ContactsPrimary ContactUpdate Lamar, D. INTERIM DIRECTOR OF PHARMACAY 5206946127Weibel, Kurt Director of Pharmacy Services 52069460616/22/2017 10:57 AM
ContactsAuthorizing OfficialUpdate BURNS, KEVIN J. CFO 5206944082Mohesky, Debra CFO 60283936204/28/2017 6:03 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse9/2/2016 2:20 AM
DetailsLast Recertification DateUpdate 8/26/2015 12:00:00 AM9/2/2016 12:00:00 AM9/2/2016 2:20 AM
DetailsLast Recertification DateUpdate 8/20/2014 12:00:00 AM8/26/2015 12:00:00 AM8/26/2015 6:38 AM
Medicaid BillingNPI: NumberInsert  12658201795/11/2015 11:28 AM
Medicaid BillingNPI: NumberInsert  12759210825/11/2015 11:28 AM
DetailsEntity NameUpdate UNIVERSITY MEDICAL CENTERBanner - University Medical Center Tucson4/14/2015 2:57 PM
Medicaid BillingNPI: NumberInsert  11543848991/12/2015 8:30 PM
Medicaid BillingNPI: NumberInsert  13069083551/12/2015 8:30 PM
Medicaid BillingNPI: NumberInsert  15886149111/12/2015 8:30 PM
DetailsLast Recertification DateUpdate 8/28/2013 12:00:00 AM8/20/2014 12:00:00 AM8/20/2014 11:58 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/28/2013 12:00:00 AM8/28/2013 6:51 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/14/2012 8:01 AM
ContactsAuthorizing OfficialInsert  BURNS, KEVIN J. CFO 52069440826/2/2008 11:05 AM
ContactsPrimary ContactInsert  Lamar, D. INTERIM DIRECTOR OF PHARMACAY 520694612712/29/2006 5:50 AM
Medicaid BillingMedicaid: Is PrimaryInsert  True10/24/2006 2:44 PM
Medicaid BillingMedicaid: NumberInsert  020470-0110/24/2006 2:44 PM
Medicaid BillingMedicaid: StateInsert  AZ10/24/2006 2:44 PM
DetailsLast Recertification DateInsert   10/24/2006 2:44 PM
DetailsGrant NumberInsert   10/24/2006 2:44 PM
Details340B IDInsert  DSH03006410/24/2006 2:44 PM
DetailsIs Authorizing Official EHB DataInsert   10/24/2006 2:44 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/24/2006 2:44 PM
DetailsMedicare Provider NumberInsert  03006410/24/2006 2:44 PM
DetailsEntity NameInsert  UNIVERSITY MEDICAL CENTER10/24/2006 2:44 PM
DetailsProgram CodeInsert  DSH10/24/2006 2:44 PM
DetailsEntity SubnameInsert   10/24/2006 2:44 PM
DatesParticipating Approval DateInsert  10/24/2006 12:00:00 AM10/24/2006 2:44 PM
DetailsStateInsert  Active10/24/2006 2:44 PM
DatesRegistration DateInsert  10/24/2006 12:00:00 AM10/24/2006 2:44 PM
DatesSigned By DateInsert   10/24/2006 2:44 PM
DatesStart DateInsert  1/1/1997 12:00:00 AM10/24/2006 2:44 PM
TerminationsTermination CommentsInsert   10/24/2006 2:44 PM
TerminationsTermination DateInsert   10/24/2006 2:44 PM
TerminationsTermination Effective DateInsert   10/24/2006 2:44 PM
TerminationsTermination ReasonInsert   10/24/2006 2:44 PM
DetailsComments PublicInsert  1/11/12 Add New bill to address, Change AO and PC JH10/24/2006 2:44 PM