340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH030022I MARICOPA MEDICAL CENTER (Terminated)
Print
Main Details
Name
MARICOPA MEDICAL CENTER
Subdivision Name
AVONDALE FAMILY HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030022I
Medicare Provider Number
030022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/29/2016
Last Recertification Date
11/5/2017
Termination Date
Termination Reason
4/1/2018
Other
Contacts
Authorizing Official
Maricopa County Special Health Care District
Richard Mutarelli, Executive Vice President, Chief Financial Officer
(602) 344-8425
Primary Contact
Maricopa Integrated Health System
Donald L Holladay, Assistant Director of Pharmacy
(602) 344-8565
Addresses
Street Address
950 EAST VAN BUREN
AVONDALE, AZ 85323
Billing Address
MARICOPA MEDICAL CENTER
2601 E ROOSEVELT
PHOENIX, AZ 85008
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
1
to
2
of
2
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
2
of
2
Page:
of 1
Go
Page size:
Change
4/29/16 Participated starting 7/1/2000, terminated 4/1/2012, reinstated 7/1/2016.
04/29/2016
03/05/2012 duplicate record of FQHCLA225G
03/05/2012
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session