340B Drug Pricing Program Database
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DSH030014U HONORHEALTH JOHN C. LINCOLN MED CTR (Terminated)
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Main Details
Name
HONORHEALTH JOHN C. LINCOLN MED CTR
Subdivision Name
Virginia G Piper Cancer Care Network-Wickenburg
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030014U
Medicare Provider Number
030014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/11/2018
Last Recertification Date
8/24/2021
Termination Date
Termination Reason
10/1/2021
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 Director
(602) 793-5509
Addresses
Street Address
519 Rose Ln
Wickenburg, AZ 85390
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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May 2025
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