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DSH030024H ST JOSEPH'S HOSPITAL AND MEDICAL CENTER (Terminated)
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Main Details
Name
ST JOSEPH'S HOSPITAL AND MEDICAL CENTER
Subdivision Name
Cancer/Oncology Clinic 3 - Cancer/Oncology Clinic 3
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030024H
Medicare Provider Number
030024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/17/2018
Last Recertification Date
8/23/2021
Termination Date
Termination Reason
7/1/2022
Site closure
Contacts
Authorizing Official
St.Joseph's Hospital and Medical Center
Jeffrey Jackson, Chief Financial Officer
(602) 406-4618
Primary Contact
CommonSpirit Health
Ryan Pearcy, 340B Region Manager
(859) 229-5654
Addresses
Street Address
500 W Thomas Rd
720
Phoenix, AZ 85013
Billing Address
Dignity Health AP
3033 N 3rd Ave
Phoneix, AZ 85013
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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