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CH09307R Mountain Park Health Center (Terminated)
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Main Details
Name
Mountain Park Health Center
Subdivision Name
Temporary Site- Mountain Park Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-031041
340B ID
CH09307R
Grant Number
H80CS00141
Additional Details
Current Program Status
Terminated
Registration Date
7/29/2020
Participating Start Date
7/30/2020
Participating Approval Date
7/30/2020
Last Recertification Date
Termination Date
Termination Reason
1/1/2021
Other
Contacts
Authorizing Official
Mountain Park Health Center
John R. Swagert, CEO
(602) 323-3470
Primary Contact
Mountain Park Health Center
Mary Soto, Associate Director of Pharmacy
(602) 586-3026
Addresses
Street Address
303 E Baseline Rd Ste 105
Phoenix, AZ 85042-6561
Billing Address
Mountain Park Health Center - Central Office
3003 N Central Ave
Ste 1600
Phoenix, AZ 85012
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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