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PED033302-21 PHOENIX CHILDREN'S HOSPITAL (Active)
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Main Details
Name
PHOENIX CHILDREN'S HOSPITAL
Subdivision Name
Phoenix Children’s Northwest Valley Specialty Care Center - Neurology
Type
Children's Hospital
Rural
No
340B ID
PED033302-21
Medicare Provider Number
033302
Outpatient Facility Provider Number
033302
Additional Details
Current Program Status
Active
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/4/2014
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Phoenix Children's Hospital
Michelle Bruhn, Executive Vice President & Chief Financial Officer
(602) 933-0221
Primary Contact
Phoenix Children's Hospital
Syed Jaffery, Director of Pharmacy Business Operations
(602) 933-5185
Addresses
Street Address
6524 W SACK DR
Suite 210
Glendale, AZ 85308
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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