340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
SCH030033-00 Banner Payson Medical Center (Terminated)
Print
Main Details
Name
Banner Payson Medical Center
Subdivision Name
Type
Sole Community Hospital
Rural
No
340B ID
SCH030033-00
Medicare Provider Number
030033
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/8/2016
Last Recertification Date
8/28/2019
Termination Date
Termination Reason
10/1/2019
Other
Contacts
Authorizing Official
Banner Payson Medical Center
Matthew K King, Senior Finance Director
(801) 682-9661
Primary Contact
Banner Payson Medical Center
Micaela Pommerening, Pharmacy Senior Manager
(928) 471-1242
Addresses
Street Address
807 S. PONDEROSA STREET
PAYSON, AZ 85541
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
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