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DSH030130 Banner Ironwood Medical Center (Active)
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Main Details
Name
Banner Ironwood Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH030130
Medicare Provider Number
030130
Additional Details
Current Program Status
Active
Registration Date
2/7/2012
Participating Start Date
4/1/2012
Participating Approval Date
2/22/2012
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Banner Ironwood Medical Center
Judd Taylor, Chief Financial Officer
(480) 394-4396
Primary Contact
Banner Ironwood Medical Center
Christina Larson, Director of Pharmacy
(480) 394-4335
Addresses
Street Address
37000 N. Gantzel Road
Queen Creek, AZ 85140
Billing Address
Banner Health Accounts Payable
P.O. Box 2977
Phoenix, AZ 85062
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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