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HOFFMAN DRUG
CAH061306-00 LINCOLN COMMUNITY HOSPITAL
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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
1/16/2018
Contract Begin Date
4/1/2018
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
1/12/2018
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