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DSH030022Z MARICOPA MEDICAL CENTER (Terminated)
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Main Details
Name
MARICOPA MEDICAL CENTER
Subdivision Name
Comprehensive Health Center-Women's Center FHC Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030022Z
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
11/5/2017
Termination Date
Termination Reason
4/1/2018
Other
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
Donald L Holladay, Assistant Director of Pharmacy
(602) 344-8565
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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