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DIPLOMAT SPECIALTY INFUSION GROUP
DSH050348 UCI MEDICAL CENTER
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Covered Entity Details
Entity Name
UCI MEDICAL CENTER
Subdivision Name
UNIVERSITY OF CALIFORNIA, IRVINE
Type
Disproportionate Share Hospital
340B ID
DSH050348
Entity Address
101 THE CITY DR. S RT32
ORANGE, CA 92868
Medicare Provider Number
050348
Participating Start Date
1/1/1998
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY INFUSION GROUP
Pharmacy Address
1819 ASTON AVE.
SUITE 104
CARLSBAD, CA 92008-7338
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/30/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Chad Thurman Lefteris, CEO
(714) 714-1423
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/12/2021
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