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DIAMOND PHARMACY SERVICE
STD55021 MCF- Faribault
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Covered Entity Details
Entity Name
MCF- Faribault
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD55021
Entity Address
1101 LINDEN LANE
FARIBAULT, MN 55021
Grant Number
5 NH25PS005172-03-00
Participating Start Date
7/1/2019
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
DIAMOND PHARMACY SERVICE
Pharmacy Address
DIAMOND PHARMACY SERVICES
645 KOLTER DRIVE
INDIANA, PA 15701
Pharmacy Comments
Contract Details
Approval Date
10/18/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michelle Smith, Deputy Commissioner
(651) 361-7217
Contract Pharmacy Representative
Diamond Pharmacy Services
Mark Zilmer, Chief Operating Officer
(800) 882-6337 Ext: 1036
Signed By Date
10/18/2019
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