340B Drug Pricing Program Database
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DSH030014Y JOHN C. LINCOLN MEDICAL CENTER (Terminated)
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Main Details
Name
JOHN C. LINCOLN MEDICAL CENTER
Subdivision Name
JCLMC Infusion Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030014Y
Medicare Provider Number
030014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/9/2020
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
7/1/2021
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
3501 N Scottsdale Rd #136
Scottsdale, AZ 85251
Billing Address
John C. Lincoln Medical Center
PO Box 14890
Scottsdale, AZ 85267
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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