340B Drug Pricing Program Database
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DSH030022DM MARICOPA MEDICAL CENTER (Terminated)
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Main Details
Name
MARICOPA MEDICAL CENTER
Subdivision Name
COMPREHENSIVE HEALTHCARE CENTER / NUTRITION 100301410
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030022DM
Medicare Provider Number
030022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/16/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/22/2017
Last Recertification Date
8/22/2018
Termination Date
Termination Reason
10/1/2018
Never implemented the 340B Program
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
2525 E ROOSEVELT ST
PHOENIX, AZ 85008-4948
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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