340B Drug Pricing Program Database
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DSH030111P Banner – University Medical Center South (Terminated)
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Main Details
Name
Banner – University Medical Center South
Subdivision Name
Diabetes Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH030111P
Medicare Provider Number
030111
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/13/2015
Last Recertification Date
9/9/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Banner University Medical Centers Tucson and South
Brad Hipp, Chief Financial Officer
(520) 694-3446
Primary Contact
Banner University Medical Center Tucson
Kurt Weibel, Director of Pharmacy Services
(520) 694-6061
Addresses
Street Address
3950 S. Country Club Road
Suite 140
Tucson, AZ 85714
Billing Address
Banner Health Accounts Payable
PO Box 2977
Phoenix, AZ 85062
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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