340B Drug Pricing Program Database
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DSH030014B JOHN C LINCOLN MEDICAL CENTER (Terminated)
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Main Details
Name
JOHN C LINCOLN MEDICAL CENTER
Subdivision Name
John C Lincoln Outpatient Imaging - 27th Ave. / Medical Imaging
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030014B
Medicare Provider Number
030014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/29/2015
Last Recertification Date
8/12/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
HonorHealth
Gary Baker, SVP-CEO-HOSPITAL
(480) 583-0803
Primary Contact
HonorHealth
Kristjon Lindgren, 340B Program Manager
(602) 870-6060 Ext: 331353
Addresses
Street Address
19636 N 27th Ave. #LL1
Phoenix, AZ 85027-4022
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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