340B Drug Pricing Program Database
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DSH030064J Banner - University Medical Center Tucson (Terminated)
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Main Details
Name
Banner - University Medical Center Tucson
Subdivision Name
PBC UC-GV Primary Care-Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030064J
Medicare Provider Number
030064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/28/2008
Participating Start Date
7/1/2008
Participating Approval Date
6/2/2008
Last Recertification Date
9/4/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Banner University Medical Centers Tucson and South
Brad Hipp, Chief Financial Officer
(520) 694-3446
Primary Contact
Banner University Medical Center Tucson
Kurt Weibel, Director of Pharmacy Services
(520) 694-6061
Addresses
Street Address
1141 S. LA CANADA DR.
GREEN VALLEY, AZ 85614
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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1/11/12 Add New bill to address, Change AO and PC JH
05/28/2008
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