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DIPLOMAT SPECIALTY PHARMACY OF PHOENIX,
SCH270051-00 KALISPELL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
KALISPELL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH270051-00
Entity Address
310 SUNNYVIEW LANE
KALISPELL, MT 59901
Medicare Provider Number
270051
Participating Start Date
9/24/2010
Last Recertification Date
9/11/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY PHARMACY OF PHOENIX,
Pharmacy Address
DIPLOMAT SPECIALTY PHARMACY
485 N. JUNIPER DR
CHANDLER, AZ 85226
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
12/13/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Deborah M Wilson, Chief Operating Officer
(406) 752-1724
Contract Pharmacy Representative
Diplomat
Sandra Barbosa, Pharmacy Manager
(602) 366-4692
Signed By Date
7/12/2019
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