340B Drug Pricing Program Database
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DSH030024C ST JOSEPH'S HOSPITAL AND MEDICAL CENTER (Terminated)
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Main Details
Name
ST JOSEPH'S HOSPITAL AND MEDICAL CENTER
Subdivision Name
Trauma Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030024C
Medicare Provider Number
030024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/14/2014
Last Recertification Date
8/23/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
St.Joseph's Hospital and Medical Center
Jeffrey Jackson, Chief Financial Officer
(602) 406-4618
Primary Contact
CommonSpirit Health
Ryan Pearcy, 340B Region Manager
(859) 229-5654
Addresses
Street Address
500 West Thomas Rd
Suite 400
Phoenix, AZ 85013
Billing Address
Dignity Health Accounts Payable
3033 N. 3rd Avenue
Phoenix, AZ 85013
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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