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CAH031318-00 BANNER PAYSON MEDICAL CENTER (Active)
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Main Details
Name
BANNER PAYSON MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH031318-00
Medicare Provider Number
031318
Additional Details
Current Program Status
Active
Registration Date
10/7/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/11/2019
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Banner Payson Medical Center
Matthew K King, Senior Finance Director
(801) 682-9661
Primary Contact
Banner Payson Medical Center
Kelly Odegaard, Associate Director of Pharmacy Services
(928) 978-9562
Addresses
Street Address
807 S. PONDEROSA
PAYSON, AZ 85541
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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