340B Drug Pricing Program Database
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DSH030002X Banner – University Medical Center Phoenix (Terminated)
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Main Details
Name
Banner – University Medical Center Phoenix
Subdivision Name
Headache Clinic - Headache Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030002X
Medicare Provider Number
030002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/16/2018
Last Recertification Date
8/16/2021
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Banner University Medical Center Phoenix
John W. Scherpf, Chief Operating Officer
(602) 839-8504
Primary Contact
Banner University Medical Center Phoenix
Jeff Anderson, Director, Pharmacy Academic
(602) 839-2657
Addresses
Street Address
755 East McDowell Road
3rd Floor
Phoenix, AZ 85006
Billing Address
Banner Health Accounts Payable
PO Box 2977
Phoenix, AZ 85062
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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