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RRC030092-03 DEER VALLEY MEDICAL CENTER (Terminated)
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Main Details
Name
DEER VALLEY MEDICAL CENTER
Subdivision Name
OR Outpatient Surgery
Type
Rural Referral Center
Rural
Yes
340B ID
RRC030092-03
Medicare Provider Number
030092
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/16/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/19/2017
Last Recertification Date
9/13/2019
Termination Date
Termination Reason
7/1/2020
For-Profit conversion
Contacts
Authorizing Official
HonorHealth
Gary Baker, SVP-CEO-HOSPITAL
(480) 583-0803
Primary Contact
HonorHealth
Kristjon Lindgren, 340B Program Director
(602) 793-5509
Addresses
Street Address
19646 N 27th Ave MOB III #101
Phoenix, AZ 85027
Billing Address
DEER VALLEY MEDICAL CENTER
19829 N 27th Ave
Phoenix, AZ 85027
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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