340B Drug Pricing Program Database
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DSH030111L Banner - University Medical Center South (Terminated)
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Main Details
Name
Banner - University Medical Center South
Subdivision Name
Alvernon Ophthamology and Optometry
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH030111L
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
8/26/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Banner University Medical Centers Tucson and South
Brad Hipp, Chief Financial Officer
(520) 694-3446
Primary Contact
Albert Cortese, Director of Pharmacy Services
(520) 874-2510
Addresses
Street Address
707 N. Alvernon, Suite 301
Tucson, AZ 85711
Billing Address
Banner University Medical Center South
2800 E. Ajo Way
attn: Pharmacy
Tucson, AZ 85713
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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