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DIAMOND PHARMACY SERVICE
STD18612 Pennsylvania Department of Corrections
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Covered Entity Details
Entity Name
Pennsylvania Department of Corrections
Subdivision Name
State Correctional Institution Dallas
Type
Sexually Transmitted Diseases
340B ID
STD18612
Entity Address
1000 Follies Road
Dallas, PA 18612
Grant Number
NU62PS924544
Participating Start Date
4/1/2023
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
DIAMOND PHARMACY SERVICE
Pharmacy Address
DIAMOND PHARMACY SERVICES
645 KOLTER DRIVE
INDIANA, PA 15701
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erica Benning, Director of Healthcare
(717) 728-5311
Contract Pharmacy Representative
Diamond Pharmacy Services
Gustave A. Gabrielson, Account Executive
(724) 349-1111 Ext: 1018
Signed By Date
4/11/2023
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