340B Drug Pricing Program Database
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PED033302-104 PHOENIX CHILDREN'S HOSPITAL (Terminated)
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Main Details
Name
PHOENIX CHILDREN'S HOSPITAL
Subdivision Name
Phoenix Children's Pediatrics
Type
Children's Hospital
Rural
No
340B ID
PED033302-104
Medicare Provider Number
033302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/15/2019
Last Recertification Date
9/8/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Phoenix Children's Hospital
Kari Cornicelli, Executive Vice President and Chief Financial Officer
(602) 933-5468
Primary Contact
Phoenix Children's Hospital
Syed Jaffery, Director of Pharmacy Business Operations
(602) 933-5185
Addresses
Street Address
1501 N Gilbert Road
Suite 203
Gilbert, AZ 85296
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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