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ARIZONA CVS STORES, L.L.C.
DSH030014 HONORHEALTH JOHN C. LINCOLN MED CTR
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Covered Entity Details
Entity Name
HONORHEALTH JOHN C. LINCOLN MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030014
Entity Address
250 E Dunlap Ave
Phoenix, AZ 85020
Medicare Provider Number
030014
Participating Start Date
7/1/2015
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09213
305 E. BROWN RD.
MESA, AZ 85201
Pharmacy Comments
Contract Details
Approval Date
7/5/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Montman, SVP/CFO
(480) 587-5120
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/5/2024
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