340B Drug Pricing Program Database
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DSH030111T Banner – University Medical Center South (Terminated)
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Main Details
Name
Banner – University Medical Center South
Subdivision Name
Clinic - Alvernon - PBC Alvernon-Geriatric Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH030111T
Medicare Provider Number
030111
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2021
Participating Start Date
7/1/2021
Participating Approval Date
5/27/2021
Last Recertification Date
Termination Date
Termination Reason
10/1/2021
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
707 N Alvernon Way
101
Tucson, AZ 85711
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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