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DSH030122R BANNER GATEWAY MEDICAL CENTER (Active)
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Main Details
Name
BANNER GATEWAY MEDICAL CENTER
Subdivision Name
MD ANDERSON - BANNER CANCER SPECIALIST CLINICS - C/P-SUPPORT SERVICES-CLINIC (HEMATOLOGY) - HEMATOLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030122R
Medicare Provider Number
030122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2024
Participating Start Date
1/1/2025
Participating Approval Date
12/9/2024
Last Recertification Date
Contacts
Authorizing Official
Banner Gateway Medical Center
Ana Barraza, CFO
(480) 543-2277
Primary Contact
Banner Gateway Medical Center
Tanya Nacy, Pharmacy Director
(480) 543-2190
Addresses
Street Address
1920 N HIGLEY RD
108
GILBERT, AZ 85234
Billing Address
BANNER HEALTH ACCOUNTS PAYABLE
PO BOX 2977
PHOENIX, AZ 85062
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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