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DSH030014V HONORHEALTH JOHN C. LINCOLN MED CTR (Active)
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Main Details
Name
HONORHEALTH JOHN C. LINCOLN MED CTR
Subdivision Name
HonorHealth Cancer Care - Fountain Hills
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030014V
Medicare Provider Number
030014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/25/2023
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
16716 E Palisades Blvd #103
Fountain Hills, AZ 85268
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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Participating from effective date: (7/1/2018) until terminated effective date: ( 7/1/2022), reinstatement effective date: (10/1/2023)
07/24/2023
May 2025
May 2025
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