340B Drug Pricing Program Database
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DSH030014H JOHN C LINCOLN MEDICAL CENTER (Terminated)
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Main Details
Name
JOHN C LINCOLN MEDICAL CENTER
Subdivision Name
Comprehensive Care Center / Senior Support Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030014H
Medicare Provider Number
030014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2017
Participating Start Date
4/1/2017
Participating Approval Date
1/9/2017
Last Recertification Date
11/8/2017
Termination Date
Termination Reason
10/1/2018
Change of covered entity type (non-hospital)
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
9225 N 3rd St
Suite 103
Phoenix, AZ 85020
Billing Address
JOHN C. LINCOLN MEDICAL CENTER
250 E DUNLAP AVE
Phoenix, AZ 85020
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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