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DIPLOMAT SPECIALTY PHARMACY OF FT LAUDER
DSH060024 UNIVERSITY OF COLORADO HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF COLORADO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060024
Entity Address
12605 E 16th Ave
AURORA, CO 80045
Medicare Provider Number
060024
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
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
7/5/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/24/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ANTHONY C. DEFURIO, VICE PRESIDENT, FINANCE/CFO
(720) 848-7836
Contract Pharmacy Representative
Diplomat Specialty Pharmacy
Matthew Cole, Pharmacist
(954) 527-0440
Signed By Date
7/5/2016
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