Contract Pharmacy Details

BANNER FAMILY PHARMACY
DSH030002 Banner – University Medical Center Phoenix

Covered Entity Details

Entity Name

Banner – University Medical Center Phoenix

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH030002

Entity Address

1111 EAST MCDOWELL ROAD
PHOENIX, AZ 85006

Medicare Provider Number

030002

Participating Start Date

9/9/2005

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

BANNER FAMILY PHARMACY

Pharmacy Address

BANNER HEALTH :
1111 E.MCDOWELL RD.
PHOENIX, AZ 85006

Pharmacy Comments

Contract Details

Approval Date

1/13/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Cliff Loader, Chief Financial Officer
(602) 839-2675

Contract Pharmacy Representative

Banner Health
Russell Funk, CEO Banner Pharmacy Services
(602) 747-4197

Signed By Date

1/13/2014

340B Drug Pricing Program Database