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PED033302-61 PHOENIX CHILDREN'S HOSPITAL (Active)
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Main Details
Name
PHOENIX CHILDREN'S HOSPITAL
Subdivision Name
Phoenix Children’s Southwest Valley Specialty Care Center – Urology
Type
Children's Hospital
Rural
No
340B ID
PED033302-61
Medicare Provider Number
033302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/6/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/10/2014
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
1665 N Avondale Boulevard
Suite 103
Avondale, AZ 85392
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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