Contract Pharmacy Details

DIPLOMAT SPECIALTY PHARMACY
DSH370093 OU MEDICAL CENTER

Covered Entity Details

Entity Name

OU MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370093

Entity Address

700 NE 13TH ST.
OKLAHOMA CITY, OK 73104

Medicare Provider Number

370093

Participating Start Date

7/1/2018

Last Recertification Date

9/4/2024

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

10/13/2020

Contract Begin Date

10/27/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/9/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

James Michael Watson, CFO
(405) 271-5100

Contract Pharmacy Representative

Optum Rx
Brandy Johnson, 340B National Account Manager
(480) 258-4321

Signed By Date

10/13/2020

340B Drug Pricing Program Database