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FQHCLA225G Maricopa County Special Health Care District (Terminated)
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Main Details
Name
Maricopa County Special Health Care District
Subdivision Name
AVONDALE FAMILY HEALTH CENTER
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-009881
340B ID
FQHCLA225G
Grant Number
LALCS00037
Additional Details
Current Program Status
Terminated
Registration Date
9/11/2007
Participating Start Date
10/1/2007
Participating Approval Date
9/14/2007
Last Recertification Date
2/14/2019
Termination Date
Termination Reason
4/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Maricopa County Special Health Care District
Richard Mutarelli, Executive Vice President, Chief Financial Officer
(602) 344-8425
Primary Contact
Maricopa County Special Health Care District
Anna Sogard, Director of Pharmacy
(602) 344-5253
Addresses
Street Address
950 E. VAN BUREN
AVONDALE, AZ 85323
Billing Address
MARICOPA MEDICAL CENTER
2601 E. ROOSEVELT STREET
PHOENIX, AZ 85008
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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03/14/2012 changed CE name (was MARICOPA MEDICAL CENTER)
09/11/2007
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