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DIAMOND PHARMACY SERVICE
STD86047 Arizona Department of Corrections, Rehabilitation and Reentry
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Covered Entity Details
Entity Name
Arizona Department of Corrections, Rehabilitation and Reentry
Subdivision Name
ASPC-Winslow/Apache
Type
Sexually Transmitted Diseases
340B ID
STD86047
Entity Address
ASPC-Winslow/Apache
2100 AZ-87
Winslow, AZ 86047
Grant Number
6NH25PS005157-02-02
Participating Start Date
7/1/2020
Last Recertification Date
5/11/2024
Pharmacy Details
Pharmacy Name
DIAMOND PHARMACY SERVICE
Pharmacy Address
DIAMOND PHARMACY SERVICES
645 KOLTER DRIVE
INDIANA, PA 15701
Pharmacy Comments
Contract Details
Approval Date
5/6/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Evitch, Assistant Director Financial Services
(602) 542-2838
Contract Pharmacy Representative
Diamond Pharmacy Services
Mark Zilmer, Chief Operating Officer
(800) 882-6337 Ext: 1036
Signed By Date
4/6/2020
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