340B Drug Pricing Program Database
BANNER FAMILY PHARMACY-THUNDERBIRD
DSH030089 BANNER THUNDERBIRD MEDICAL CENTER - information as of 4/24/2025 10:36:31 PM
Covered Entity Details
Entity Name
BANNER THUNDERBIRD MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030089
Entity Address
5555 W. Thunderbird Road
Glendale, AZ 85306
Medicare Provider Number
030089
Participating Start Date
1/1/2007
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
BANNER FAMILY PHARMACY-THUNDERBIRD
Pharmacy Address
5555 W THUNDERBIRD RD
GLENDALE, AZ 85306-4622
Pharmacy Comments
Contract Details
Approval Date
1/21/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathy Kotin, Chief Financial Officer
(602) 839-2675
Contract Pharmacy Representative
Banner Health
Russell Funk, CEO Banner Pharmacy Services
(602) 747-4197
Signed By Date
1/21/2014
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