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DSH030023 FLAGSTAFF MEDICAL CENTER (Active)
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Main Details
Name
FLAGSTAFF MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH030023
Medicare Provider Number
030023
Additional Details
Current Program Status
Active
Registration Date
6/4/2009
Participating Start Date
7/1/2009
Participating Approval Date
6/8/2009
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Northern Arizona Healthcare
Clifford F Loader, Chief Financial Officer
(928) 773-2282
Primary Contact
Northern Arizona Healthcare
Scott Waldrop, System Director of Pharmacy Services
(928) 773-2117
Addresses
Street Address
1200 NORTH BEAVER
FLAGSTAFF, AZ 86001
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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