340B Drug Pricing Program Database
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DSH030111W Banner – University Medical Center South (Terminated)
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Main Details
Name
Banner – University Medical Center South
Subdivision Name
Clinic - Ajo OB/GYN - PBC SC-Corridor Surg(Podiatry)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH030111W
Medicare Provider Number
030111
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2021
Participating Start Date
7/1/2021
Participating Approval Date
5/27/2021
Last Recertification Date
9/8/2021
Termination Date
Termination Reason
4/1/2022
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
2800 E Ajo Way
105
Tucson, AZ 85713
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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