340B Drug Pricing Program Database
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DSH030016C Banner Casa Grande Medical Center (Terminated)
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Main Details
Name
Banner Casa Grande Medical Center
Subdivision Name
Banner Casa Grande Coumadin Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030016C
Medicare Provider Number
030016
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/1/2016
Last Recertification Date
9/5/2018
Termination Date
Termination Reason
4/1/2019
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Banner Ironwood Medical Center
Jeff Allen Buehrle, CFO
(480) 394-4396
Primary Contact
Banner Pharmacy Services
Al Cortese, Sr. Director of Pharmacy
(520) 834-4210
Addresses
Street Address
1676 E. McMurray Boulevard, Suite 3
Casa Grande, AZ 85122
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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