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DSH030022CY MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT (Terminated)
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Main Details
Name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Subdivision Name
VALLEYWISE COMMUNITY HEALTH CENTER - EL MIRAGE/ CARDIOLOGY 100403090
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030022CY
Medicare Provider Number
030022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/5/2018
Participating Start Date
10/9/2018
Participating Approval Date
10/9/2018
Last Recertification Date
8/21/2020
Termination Date
Termination Reason
7/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Maricopa County Special Health Care District
Michael White, Executive Vice President, Chief Clinical Officer
(602) 344-5503
Primary Contact
Maricopa County Special Health Care District
Anna Sogard, Director of Pharmacy
(602) 344-5253
Addresses
Street Address
12428 W THUNDERBIRD RD
VALLEYWISE COMMUNITY HEALTH CENTER - EL MIRAGE
EL MIRAGE, AZ 85335-3113
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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