340B Drug Pricing Program Database

Name

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Subdivision Name

VALLEYWISE COMPREHENSIVE HEALTH CENTER PEORIA / NEUROLOGY 100701077

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH030022BJ

Medicare Provider Number

030022

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

10/5/2018

Participating Start Date

10/9/2018

Participating Approval Date

10/9/2018

Last Recertification Date

8/29/2023

Termination Date
Termination Reason

1/1/2024
Business decision by the Covered Entity

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 DBA VALLEYWISE HEALTH
Alba Misty Vo, Director of Pharmacy
(602) 344-5253

Street Address

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE COMPREHENSIVE HEALTH CENTER - PEORIA
8088 W WHITNEY DR
PEORIA, AZ 85345

Billing Address

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE HEALTH
2601 E ROOSEVELT ST
PHOENIX, AZ 85008-4948