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BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
DSH030023 FLAGSTAFF MEDICAL CENTER
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Covered Entity Details
Entity Name
FLAGSTAFF MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030023
Entity Address
1200 NORTH BEAVER
FLAGSTAFF, AZ 86001
Medicare Provider Number
030023
Participating Start Date
7/1/2009
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
Pharmacy Address
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
145 S 79TH ST STE 70
CHANDLER, AZ 85226
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifford F Loader, Chief Financial Officer
(928) 773-2282
Contract Pharmacy Representative
BioPlus Rx
Daniel Hakimi, 340b Regional Field Director West
(425) 273-7756
Signed By Date
7/8/2024
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