340B Drug Pricing Program Database
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DSH030089 BANNER THUNDERBIRD MEDICAL CENTER (Active)
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Main Details
Name
BANNER THUNDERBIRD MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030089
Medicare Provider Number
030089
Additional Details
Current Program Status
Active
Registration Date
11/30/2006
Participating Start Date
1/1/2007
Participating Approval Date
11/30/2006
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Banner Desert Medical Center
Paul Vachek, CFO - BDMC
(480) 412-3214
Primary Contact
Banner Thunderbird Medical Center
Theodore W Graphos, Director, Pharmacy
(602) 865-5709
Addresses
Street Address
5555 W. Thunderbird Road
Glendale, AZ 85306
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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