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PED033302-00 PHOENIX CHILDREN'S HOSPITAL (Active)
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Main Details
Name
PHOENIX CHILDREN'S HOSPITAL
Subdivision Name
Type
Children's Hospital
Rural
No
340B ID
PED033302-00
Medicare Provider Number
033302
Additional Details
Current Program Status
Active
Registration Date
3/25/2010
Participating Start Date
4/1/2010
Participating Approval Date
3/26/2010
Last Recertification Date
9/19/2024
Contacts
Authorizing Official
Phoenix Children's Hospital
Michelle Bruhn, Executive Vice President & Chief Financial Officer
(602) 933-0221
Primary Contact
Phoenix Children's Hospital
Syed Jaffery, Director of Pharmacy Business Operations
(602) 933-5185
Addresses
Street Address
1919 E THOMAS ROAD
PHOENIX, AZ 85016
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/12/12 ADDED SHIP ADD 2; 1/10/12 ADDED SHIP-TO ADD
04/12/2012
1/10/12 ADDED SHIP-TO ADD
01/10/2012
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