Contract Pharmacy Details

JOHN C. LINCOLN MEDICAL CENTER SPECIALTY
RRC030038-00 HONORHEALTH SCOTTSDALE OSBORN MED CT

Covered Entity Details

Entity Name

HONORHEALTH SCOTTSDALE OSBORN MED CT

Subdivision Name

Type

Rural Referral Center

340B ID

RRC030038-00

Entity Address

7400 E Osborn Rd
Scottsdale, AZ 85251

Medicare Provider Number

030038

Participating Start Date

7/1/2019

Last Recertification Date

8/23/2023

Entity Termination Date

7/1/2024

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

1/12/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

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

Signed By Date

1/12/2018

340B Drug Pricing Program Database