340B Drug Pricing Program Database
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DSH030111E Banner – University Medical Center South (Terminated)
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Main Details
Name
Banner – University Medical Center South
Subdivision Name
Multi-Specialty Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH030111E
Medicare Provider Number
030111
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/15/2011
Participating Start Date
1/1/2012
Participating Approval Date
12/27/2011
Last Recertification Date
9/9/2021
Termination Date
Termination Reason
4/1/2022
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
2800 E. Ajo Way, Suite 102
Tucson, AZ 85713
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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