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DSH030014 HONORHEALTH JOHN C. LINCOLN MED CTR (Active)
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Main Details
Name
HONORHEALTH JOHN C. LINCOLN MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030014
Medicare Provider Number
030014
Additional Details
Current Program Status
Active
Registration Date
4/14/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/26/2015
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
HonorHealth
Lisa Montman, SVP/CFO
(480) 587-5120
Primary Contact
HonorHealth
Kristjon Lindgren, 340B Program Director
(602) 793-5509
Addresses
Street Address
250 E Dunlap Ave
Phoenix, AZ 85020
Billing Address
HONORHEALTH JOHN C. LINCOLN MED CTR
PO Box 14890
Scottsdale, AZ 85267
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/26/15 previously participating 4/1/10 thru 9/30/13, not participating 10/1/13 thru 6/30/15 due to failure to recertify, reinstated based on on-line registration submitted in April 2015
05/26/2015
3/15/2010- DOC. RECD. TO CONFIRM DSH ADJ%
03/15/2010
May 2025
May 2025
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