340B Drug Pricing Program Database
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DSH030122A BANNER GATEWAY MEDICAL CENTER (Active)
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Main Details
Name
BANNER GATEWAY MEDICAL CENTER
Subdivision Name
MD ANDERSON CANCER CENTER CLINIC - AMBULATORY CARE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030122A
Medicare Provider Number
030122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
6/1/2012
Participating Start Date
10/1/2015
Participating Approval Date
6/21/2012
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Banner Gateway Medical Center
Ana Barraza, CFO
(480) 543-2277
Primary Contact
Banner Gateway Medical Center
Tanya Nacy, Pharmacy Director
(480) 543-2190
Addresses
Street Address
2946 E BANNER GATEWAY DRIVE
3RD FLOOR
GILBERT, AZ 85234
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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7/24/15 enrolled in 340B 7/1/12 thru 9/30/13, not enrolled 10/1/13 thru 9/30/15 due to DSH % dropping below statutory minimum, reinstated effective 10/1/15 based on on-line registration submitted in July 2015
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April 2025
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