340B Drug Pricing Program Database
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DSH030014F JOHN C LINCOLN MEDICAL CENTER (Terminated)
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Main Details
Name
JOHN C LINCOLN MEDICAL CENTER
Subdivision Name
Pharmacy Care Coordination
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030014F
Medicare Provider Number
030014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/16/2016
Last Recertification Date
Termination Date
Termination Reason
1/1/2018
Site closure
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
9109 North Central Avenue
Phoenix, AZ 85020
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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