340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
BANNER FAMILY PHARMACY-UNIV MED INSTITUT
DSH030002 Banner – University Medical Center Phoenix
Print
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-UNIV MED INSTITUT
Pharmacy Address
ATTN: PHARMACY DEPARTMENT
1441 N 12TH ST
PHOENIX, AZ 85006
Pharmacy Comments
Contract Details
Approval Date
10/20/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathy Kotin, Chief Financial Officer
(602) 839-2675
Contract Pharmacy Representative
Banner Health
Russell Funk, CEO Banner Pharmacy Services
(602) 747-4197
Signed By Date
10/20/2016
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session