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DIPLOMAT SPECIALTY PHARMACY
CAN100079-00 UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN100079-00
Entity Address
1475 NW 12th Avenue
2080A
Miami, FL 33136
Medicare Provider Number
100079
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY PHARMACY
Pharmacy Address
1370 BUSCH PKWY
BUFFALO GROVE, IL 60089-4505
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Michael Gittelman, CEO
(305) 326-6111
Contract Pharmacy Representative
Diplomat Pharmacy
Elizabeth Orange, Pharmacist
(847) 229-4141
Signed By Date
4/15/2019
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