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DIPLOMAT SPECIALTY PHARMACY
DSH030022 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
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Covered Entity Details
Entity Name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030022
Entity Address
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT DBA VALLEYWISE HEALTH
2601 EAST ROOSEVELT STREET
PHOENIX, AZ 85008
Medicare Provider Number
030022
Participating Start Date
10/4/2018
Last Recertification Date
8/24/2024
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY PHARMACY
Pharmacy Address
15211 VANOWEN ST
STE 301
VAN NUYS, CA 91405
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
5/22/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/14/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Mutarelli, Executive Vice President, Chief Financial Officer
(602) 344-8425
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2020
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