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CH09307M Mountain Park Health Center (Terminated)
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Main Details
Name
Mountain Park Health Center
Subdivision Name
Mountain Park Health Center - 303 E Baseline Suite 300
Type
HRSA-Funded Health Center
Site ID
BPS-H80-018626
340B ID
CH09307M
Grant Number
H80CS00141
Additional Details
Current Program Status
Terminated
Registration Date
5/9/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/11/2018
Last Recertification Date
1/28/2020
Termination Date
Termination Reason
1/1/2021
Other
Contacts
Authorizing Official
Mountain Park Health Center
John R. Swagert, CEO
(602) 323-3470
Primary Contact
Mountain Park Health Center
Mary Soto, Associate Director of Pharmacy
(602) 586-3026
Addresses
Street Address
303 East Baseline Road
Suite 300
Phoenix, AZ 85042-6530
Billing Address
MOUNTAIN PARK HEALTH CENTER - Central Office
3003 N Central Ave
Ste 1600
Phoenix, AZ 85012-2908
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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