Contract Pharmacy Details

JOHN C. LINCOLN MEDICAL CENTER SPECIALTY
DSH030038 SCOTTSDALE OSBORN MEDICAL CENTER

Covered Entity Details

Entity Name

SCOTTSDALE OSBORN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH030038

Entity Address

7400 EAST OSBORN ROAD
SCOTTSDALE, AZ 85251

Medicare Provider Number

030038

Participating Start Date

10/1/2018

Last Recertification Date

Entity Termination Date

6/10/2019

Pharmacy Details

Pharmacy Name

JOHN C. LINCOLN MEDICAL CENTER SPECIALTY

Pharmacy Address

2500 W UTOPIA RD STE 110
PHOENIX, AZ 85027

Pharmacy Comments

Contract Details

Approval Date

7/6/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/10/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Alice Pope, Chief Financial Officer
(480) 882-5544

Contract Pharmacy Representative

HonorHealth
Susan Moravec, AVP, Chief of Phamacy
(480) 882-5941

Signed By Date

7/3/2018

340B Drug Pricing Program Database