Contract Pharmacy Details

DIPLOMAT SPECIALTY PHARMACY
STD850153 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

AZ Suite 6

Type

Sexually Transmitted Diseases

340B ID

STD850153

Entity Address

4350 N 19th Avenue
Suite 6
Phoenix, AZ 85015

Grant Number

6 NU62PS924818-01-01

Participating Start Date

1/1/2020

Last Recertification Date

5/28/2025

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

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/24/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

4/15/2021

340B Drug Pricing Program Database