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DIPLOMAT SPECIALTY PHARMACY
RRC360180-00 CLEVELAND CLINIC HOSPITAL
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Covered Entity Details
Entity Name
CLEVELAND CLINIC HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360180-00
Entity Address
9500 EUCLID AVENUE
CLEVELAND, OH 44195
Medicare Provider Number
360180
Participating Start Date
4/1/2020
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY PHARMACY
Pharmacy Address
4100 S SAGINAW ST
STE D
FLINT, MI 48507-2683
Pharmacy Comments
04/09/2012 update address and name (added suite)
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tim Longville, Chief Accounting Officer and Controller
(216) 636-7416
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2020
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