340B Drug Pricing Program Database

Name

Maricopa County Special Health Care District

Subdivision Name

SOUTH CENTRAL FHC CLINIC 100501009

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-011991

340B ID

FQHCLA225W

Grant Number

LALCS00037

Current Program Status

Terminated

Registration Date

1/9/2013

Participating Start Date

4/1/2013

Participating Approval Date

2/27/2013

Last Recertification Date

2/8/2018

Termination Date
Termination Reason

7/1/2018
Site closure

Authorizing Official

Maricopa Integrated Health Center
Kris Gaw, Chief Operating Officer
(602) 344-1258

Primary Contact

Maricopa Integrated Health System
Donald L Holladay, Assistant Director of Pharmacy
(602) 344-8565

Street Address

1616 E. Roeser Road
Phoenix, AZ 85040

Billing Address

Maricopa Medical Center
2601 E. Roosevelt
Phoenix, AZ 85008