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DIPLOMAT SPECIALTY PHARMACY
CH090710 COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
Subdivision Name
NIPOMO COMMUNITY MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH090710
Entity Address
150 TEJAS PL
NIPOMO, CA 93444-9123
Grant Number
H80CS00621
Participating Start Date
4/1/1996
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY PHARMACY
Pharmacy Address
15211 VANOWEN ST
STE 301
VAN NUYS, CA 91405
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RONALD E. CASTLE, CEO
(805) 459-1835
Contract Pharmacy Representative
Diplomat Specialty Pharmancy
Jasmen Barzivand, Pharmacist in Charge
(818) 988-1288
Signed By Date
7/12/2019
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