340B Drug Pricing Program Database
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RRC030092-08 HONORHEALTH DEER VALLEY MED CENTER (Terminated)
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Main Details
Name
HONORHEALTH DEER VALLEY MED CENTER
Subdivision Name
Breast Health Research Center
Type
Rural Referral Center
Rural
Yes
340B ID
RRC030092-08
Medicare Provider Number
030092
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
9/10/2020
Termination Date
Termination Reason
4/1/2021
Business decision by the Covered Entity
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 #205
Phoenix, AZ 85027
Billing Address
HONORHEALTH DEER VALLEY MED CENTER
PO Box 14890
Scottsdale, AZ 85267
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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