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DSH030002AC Banner – University Medical Center Phoenix (Active)
Main Details
Name
Banner – University Medical Center Phoenix
Subdivision Name
C/P ORTHO SPORTS MEDICINE - CLINI - C/P ORTHO SPORTS MEDICINE - CLINI - OSI
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030002AC
Medicare Provider Number
030002
Outpatient Facility Provider Number
Contacts
Authorizing Official
Banner University Medical Center Phoenix
Diana L Gernhart, Chief Financial Officer
(602) 839-8507
Primary Contact
Banner University Medical Center Phoenix
Jeff Anderson, Director, Pharmacy Academic
(602) 839-2657
Additional Details
Current Program Status
Active
Registration Date
11/16/2018
Participating Start Date
1/1/2019
Participating Approval Date
12/4/2018
Last Recertification Date
8/22/2023
Addresses
Street Address
755 E McDowell Rd
2nd 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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