340B Drug Pricing Program Database
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DSH030064AJ Banner - University Medical Center Tucson (Terminated)
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Main Details
Name
Banner - University Medical Center Tucson
Subdivision Name
Green Valley - PBC UC GV Otolaryngology-Clin
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030064AJ
Medicare Provider Number
030064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/8/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/19/2020
Last Recertification Date
9/4/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Banner University Medical Centers Tucson and South
Brad Hipp, Chief Financial Officer
(520) 694-3446
Primary Contact
Banner University Medical Center Tucson
Kurt Weibel, Director of Pharmacy Services
(520) 694-6061
Addresses
Street Address
1141 S. LA CANADA DR.
GREEN VALLEY, AZ 85614
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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