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DSH030089B BANNER THUNDERBIRD MEDICAL CENTER (Active)
Main Details
Name
BANNER THUNDERBIRD MEDICAL CENTER
Subdivision Name
Banner Thunderbird Medical Center - Banner Infusion Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030089B
Medicare Provider Number
030089
Outpatient Facility Provider Number
Contacts
Authorizing Official
Banner Thunderbird Medical Center
Paul Vachek, CFO - BTMC
(602) 865-5751
Primary Contact
Banner Thunderbird Medical Center
Theodore W Graphos, Director, Pharmacy
(602) 865-5709
Additional Details
Current Program Status
Active
Registration Date
7/2/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/8/2020
Last Recertification Date
8/28/2023
Addresses
Street Address
13041 N DEL WEBB BLVD
100
Sun City, AZ 85351
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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