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DSH030022AA MARICOPA MEDICAL CENTER (Terminated)
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Main Details
Name
MARICOPA MEDICAL CENTER
Subdivision Name
Comprehensive Health Center-Attendant Care Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030022AA
Medicare Provider Number
030022
Outpatient Facility Provider Number
030022
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/27/2014
Last Recertification Date
8/24/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Maricopa County Special Health Care District
Richard Mutarelli, Executive Vice President, Chief Financial Officer
(602) 344-8425
Primary Contact
Maricopa Integrated Health System
Linda T Carboni, Pharmacy Regulatory & Compliance Supervisor
(602) 344-1236
Addresses
Street Address
2525 East Roosevelt Street
Phoenix, AZ 85008
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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