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DSH030022FK MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT (Active)
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Main Details
Name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Subdivision Name
Valleywise Behavior Health Center - Maryvale Specialty Clinic - Behavioral Health Specialty Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030022FK
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
2/6/2024
Last Recertification Date
8/27/2024
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 - MARYVALE
5102 W CAMPBELL AVE 5102
Phoenix, AZ 85031
Billing Address
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE HEALTH
2601 E ROOSEVELT ST
Phoenix, AZ 85008
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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