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DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN
DSH500129 TACOMA GENERAL/ALLENMORE HOSPITAL
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Covered Entity Details
Entity Name
TACOMA GENERAL/ALLENMORE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500129
Entity Address
315 MARTIN LUTHER KING JR WAY
TACOMA, WA 98405-4234
Medicare Provider Number
500129
Participating Start Date
12/1/2005
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN
Pharmacy Address
DIPLOMAT SPECIALTY PHARMACY
1809 EXCISE AVENUE
SUITE 204-208
ONTARIO, CA 91761
Pharmacy Comments
Contract Details
Approval Date
1/5/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/3/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Diplomat
Sandra Barbosa, Pharmacy Manager
(602) 366-4692
Signed By Date
1/5/2017
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