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DIPLOMAT SPECIALTY PHARMACY
CAH161344-00 WASHINGTON COUNTY HOSPITAL
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Covered Entity Details
Entity Name
WASHINGTON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161344-00
Entity Address
400 E POLK ST.
WASHINGTON, IA 52353
Medicare Provider Number
161344
Participating Start Date
9/27/2010
Last Recertification Date
8/30/2024
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
8/3/2021
Contract Begin Date
8/3/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/19/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Shelli Cleverley, CFO
(319) 863-3902
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
8/3/2021
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