Contract Pharmacy Details

DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN
CH090780 Community Medical Centers, Inc.

Covered Entity Details

Entity Name

Community Medical Centers, Inc.

Subdivision Name

Community Medical Centers, Channel

Type

HRSA-Funded Health Center

340B ID

CH090780

Entity Address

701 E Channel St.
Stockton, CA 95202-2628

Grant Number

H80CS00138

Participating Start Date

12/1/1992

Last Recertification Date

2/21/2025

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

1/15/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/1/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Christine Noguera, CEO
(209) 373-2826

Contract Pharmacy Representative

Diplomat
Dwayne Dodd, National Sales Manager- 340B, Hospital/Health Systems
(734) 674-0050

Signed By Date

1/15/2019

340B Drug Pricing Program Database