Contract Pharmacy Details

HOFFMAN DRUG
CAH061306-01 LINCOLN COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

LINCOLN COMMUNITY HOSPITAL

Subdivision Name

Specialty Clinic

Type

Critical Access Hospital

340B ID

CAH061306-01

Entity Address

111 6th Street
Hugo, CO 80821

Medicare Provider Number

061306

Outpatient Facility Provider Number

Participating Start Date

4/1/2018

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

HOFFMAN DRUG

Pharmacy Address

900 MAIN ST
BOX 609
LIMON, CO 80828

Pharmacy Comments

Contract Details

Approval Date

10/22/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

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

10/22/2015