Contract Pharmacy Details

DIPLOMAT SPECIALTY PHARMACY OF FT LAUDER
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Covered Entity Details

Entity Name

UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230046

Entity Address

1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109

Medicare Provider Number

230046

Participating Start Date

1/1/2004

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

DIPLOMAT SPECIALTY PHARMACY OF FT LAUDER

Pharmacy Address

DIPLOMAT SPECIALTY PHARMACY
15471 SW 12TH ST
STE 207
SUNRISE, FL 33326

Pharmacy Comments

Contract Details

Approval Date

1/14/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/15/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Tony Denton, COO
(734) 647-6623

Contract Pharmacy Representative

Diplomat Specialty Pharmacy
Matthew Cole, Pharmacist
(954) 527-0440

Signed By Date

1/14/2016

340B Drug Pricing Program Database