340B Drug Pricing Program Database
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DSH030002AF Banner – University Medical Center Phoenix (Terminated)
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Main Details
Name
Banner – University Medical Center Phoenix
Subdivision Name
Multiple Sclerosis (MS)-Clinic - Multiple Sclerosis (MS)-Clinic - Neurology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030002AF
Medicare Provider Number
030002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/16/2018
Participating Start Date
1/1/2019
Participating Approval Date
12/4/2018
Last Recertification Date
9/9/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Banner University Medical Center Phoenix
John W. Scherpf, Chief Operating Officer
(602) 839-8504
Primary Contact
Banner University Medical Center Phoenix
Jeff Anderson, Director, Pharmacy Academic
(602) 839-2657
Addresses
Street Address
755 E McDowell Rd , Third Floor , Phoenix AZ 85006
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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