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DSH030122B BANNER GATEWAY MEDICAL CENTER (Terminated)
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Main Details
Name
BANNER GATEWAY MEDICAL CENTER
Subdivision Name
Banner Gateway Surgery Center Ste 100
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030122B
Medicare Provider Number
030122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
8/23/2023
Termination Date
Termination Reason
10/1/2024
Site closure
Contacts
Authorizing Official
Banner Gateway Medical Center
Ana Barraza, CFO
(480) 543-2277
Primary Contact
Banner Gateway Medical Center
Tanya Nacy, Pharmacy Director
(480) 543-2190
Addresses
Street Address
2940 E BANNER GATEWAY DRIVE
BANNER GATEWAY SURGERY CENTER
SUITE 100
GILBERT, AZ 85234-2176
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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