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PED033302-94 PHOENIX CHILDREN'S HOSPITAL (Terminated)
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Main Details
Name
PHOENIX CHILDREN'S HOSPITAL
Subdivision Name
Phoenix Children’s Pediatrics – North Phoenix
Type
Children's Hospital
Rural
No
340B ID
PED033302-94
Medicare Provider Number
033302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/17/2018
Last Recertification Date
9/15/2022
Termination Date
Termination Reason
7/1/2023
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Phoenix Children's Hospital
Dennis Bruns, Executive Vice President & Chief Financial Officer
(602) 933-0221
Primary Contact
Phoenix Children's Hospital
Syed Jaffery, Director of Pharmacy Business Operations
(602) 933-5185
Addresses
Street Address
3805 E Bell Road
Suite 5100
Phoenix, AZ 85032
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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