Contract Pharmacy Details

DIPLOMAT SPECIALTY PHARMACY
DSH230207 McLaren Oakland

Covered Entity Details

Entity Name

McLaren Oakland

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230207

Entity Address

50 NORTH PERRY
PONTIAC, MI 48342

Medicare Provider Number

230207

Participating Start Date

1/1/2005

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

DIPLOMAT SPECIALTY PHARMACY

Pharmacy Address

4100 S SAGINAW ST
STE D
FLINT, MI 48507-2683

Pharmacy Comments

04/09/2012 update address and name (added suite)

Contract Details

Approval Date

1/14/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

FRED KORTE, CFO
(248) 338-5691

Contract Pharmacy Representative

Greg Jonas, Manager
(810) 230-5045

Signed By Date

1/14/2014