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DSH030115 BANNER ESTRELLA MEDICAL CENTER (Active)
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Main Details
Name
BANNER ESTRELLA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH030115
Medicare Provider Number
030115
Additional Details
Current Program Status
Active
Registration Date
6/15/2007
Participating Start Date
7/1/2007
Participating Approval Date
6/15/2007
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Banner Estrella Medical Center
Nick Brooks, Chief Financial Officer
(623) 327-5026
Primary Contact
Banner Estrella Medical Center
Kent R. Montierth, DIRECTOR OF PHARMACY
(623) 327-5007
Addresses
Street Address
9201 WEST THOMAS ROAD
PHOENIX, AZ 85037
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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April 2025
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