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DSH030024F ST JOSEPH'S HOSPITAL AND MEDICAL CENTER (Active)
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Main Details
Name
ST JOSEPH'S HOSPITAL AND MEDICAL CENTER
Subdivision Name
OP Infusion
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030024F
Medicare Provider Number
030024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/23/2015
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
St.Joseph's Hospital and Medical Center
Jeffrey Jackson, Chief Financial Officer
(602) 406-4618
Primary Contact
CommonSpirit Health - Central Region
Mitchell Schultz, RPh, 340b Regional Manager
(701) 928-0620
Addresses
Street Address
500 West Thomas Road
Suite 650
Phoenix, AZ 85013
Billing Address
Dignity Health AP
3033 N. 3rd Ave
Phoenix, AZ 85013
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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