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DIPLOMAT SPECIALTY PHARMACY
DSH150113 COMMUNITY HOSPITAL ANDERSON
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL ANDERSON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150113
Entity Address
1515 NORTH MADISON AVE
ANDERSON, IN 46011
Medicare Provider Number
150113
Participating Start Date
4/1/2021
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY PHARMACY
Pharmacy Address
4100 S SAGINAW ST
STE D
FLINT, MI 48507-2683
Pharmacy Comments
04/09/2012 update address and name (added suite)
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Beth Tharp, SVP/President of Hospital Services
(765) 298-5125
Contract Pharmacy Representative
Diplomat Specialty Pharmacy
Greg Jonas, Associate Director Pharmacy
(810) 768-9458
Signed By Date
4/12/2019
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