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DIPLOMAT SPECIALTY PHARMACY
CH090780 Community Medical Centers, Inc.
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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
Pharmacy Address
15211 VANOWEN ST
STE 301
VAN NUYS, CA 91405
Pharmacy Comments
Contract Details
Approval Date
7/18/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/29/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christine Noguera, CEO
(209) 373-2826
Contract Pharmacy Representative
Diplomat Specialty Pharmancy
Jasmen Barzivand, Pharmacist in Charge
(818) 988-1288
Signed By Date
7/18/2019
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