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DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN
FQHCLA270 CASTLE FAMILY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
CASTLE FAMILY HEALTH CENTERS, INC.
Subdivision Name
CASTLE FAMILY HEALTH CENTERS AT CASTLE
Type
Health Center Program Look-Alike
340B ID
FQHCLA270
Entity Address
3605 HOSPITAL ROAD
ATWATER, CA 95301-5173
Grant Number
LALCS00012
Participating Start Date
10/1/2010
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN
Pharmacy Address
DIPLOMAT SPECIALTY PHARMACY
1809 EXCISE AVENUE
SUITE 204-208
ONTARIO, CA 91761
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/31/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Edward Lujano, CEO
(209) 381-2000 Ext: 7001
Contract Pharmacy Representative
Diplomat
Dwayne Dodd, National Sales Manager- 340B, Hospital/Health Systems
(734) 674-0050
Signed By Date
7/16/2018
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