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DSH030022BM MARICOPA MEDICAL CENTER (Terminated)
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Main Details
Name
MARICOPA MEDICAL CENTER
Subdivision Name
Pendergast Family Health Center / DENTAL CLINIC 100413700
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030022BM
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
8/27/2019
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Maricopa County Special Health Care District
Richard Mutarelli, Executive Vice President, Chief Financial Officer
(602) 344-8425
Primary Contact
Maricopa County Special Health Care District
Anna Sogard, Director of Pharmacy
(602) 344-5253
Addresses
Street Address
10550 W MARIPOSA ST
STE 1
PHOENIX, AZ 85037-5082
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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