340B Drug Pricing Program Database
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DSH030064CB Banner - University Medical Center Tucson (Terminated)
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Main Details
Name
Banner - University Medical Center Tucson
Subdivision Name
PBC UC-GV Gen Surg - Clinic - General Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030064CB
Medicare Provider Number
030064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/19/2021
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
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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