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FQHCLA225 Maricopa County Special Health Care District (Terminated)
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Main Details
Name
Maricopa County Special Health Care District
Subdivision Name
Type
Health Center Program Look-Alike
Site ID
Admin
340B ID
FQHCLA225
Grant Number
LALCS00037
Additional Details
Current Program Status
Terminated
Registration Date
9/14/2007
Participating Start Date
10/1/2007
Participating Approval Date
9/14/2007
Last Recertification Date
2/15/2019
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
2601 E. ROOSEVELT STREET
PHOENIX, AZ 85008
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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03/05/2012 added as ship to (MMC Outpatient Pharmacy) for DSH030022
03/05/2012
03/05/2012 duplicate of DSH030022
03/05/2012
April 2025
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