340B Drug Pricing Program Database

Name

Maricopa County Special Health Care District

Subdivision Name

Whole Health Home Clinic SWN San Tan

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-011992

340B ID

FQHCLA225R

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

10/1/2018
Business decision by the Covered Entity

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

1465 W. Chandler Blvd BLDG A
Chandler, AZ 85224

Billing Address

Maricopa Medical Center
2601 E. Roosevelt
Phoenix, AZ 85008