340B Drug Pricing Program Database

Name

Maricopa County Special Health Care District

Subdivision Name

Pendergast Family Health Center

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-014639

340B ID

FQHCLA225X

Grant Number

LALCS00037

Current Program Status

Terminated

Registration Date

10/7/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/30/2015

Last Recertification Date

2/8/2018

Termination Date
Termination Reason

10/1/2018
Business decision by the Covered Entity

Authorizing Official

Maricopa Integrated Health Center
Kris Gaw, Chief Operating Officer
(602) 344-1258

Primary Contact

Maricopa Integrated Health System
Donald L Holladay, Assistant Director of Pharmacy
(602) 344-8565

Street Address

10550 W Mariposa Street
Phoenix, AZ 85037

Billing Address

Maricopa Medical Center
2601 E. Roosevelt Street
Phoenix, AZ 85008