Contract Pharmacy Details

DIPLOMAT SPECIALTY PHARMACY OF FT LAUDER
CH103100 UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health

Covered Entity Details

Entity Name

UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health

Subdivision Name

Umpqua Community Health Center

Type

HRSA-Funded Health Center

340B ID

CH103100

Entity Address

150 NE Kenneth Ford Drive
Roseburg, OR 97470

Grant Number

H80CS00567

Participating Start Date

10/1/2003

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

DIPLOMAT SPECIALTY PHARMACY OF FT LAUDER

Pharmacy Address

DIPLOMAT SPECIALTY PHARMACY
15471 SW 12TH ST
STE 207
SUNRISE, FL 33326

Pharmacy Comments

Contract Details

Approval Date

7/2/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/1/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Linda Mullins, CEO
(541) 672-9596 Ext: 100

Contract Pharmacy Representative

Phil Hagerman, Chief Executive Officer
(810) 768-9453

Signed By Date

7/2/2013

340B Drug Pricing Program Database