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DIPLOMAT SPECIALTY PHARMACY
CAH171362-00 Citizens Medical Center, Inc.
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Covered Entity Details
Entity Name
Citizens Medical Center, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171362-00
Entity Address
100 E College Drive
Colby, KS 67701
Medicare Provider Number
171362
Participating Start Date
7/1/2013
Last Recertification Date
8/15/2024
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
6/24/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Greg Unruh, CEO
(785) 462-7511
Contract Pharmacy Representative
Optum Rx
Brandy Johnson, 340B National Account Manager
(480) 258-4321
Signed By Date
6/24/2021
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