Contract Pharmacy Details

HOFFMAN DRUG
CAH061306-00 LINCOLN COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

LINCOLN COMMUNITY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH061306-00

Entity Address

111 6TH STREET
HUGO, CO 80821

Medicare Provider Number

061306

Participating Start Date

4/1/2018

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

HOFFMAN DRUG

Pharmacy Address

900 MAIN ST
BOX 609
LIMON, CO 80828

Pharmacy Comments

Contract Details

Approval Date

3/15/2016

Contract Begin Date

3/18/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kevin M. Stansbury, CEO
(719) 743-2421

Contract Pharmacy Representative

Hoffman Drug
Ryan Smithburg, Owner
(719) 775-2371

Signed By Date

3/15/2016