Contract Pharmacy Details

DIPLOMAT SPECIALTY PHARMACY OF FT LAUDER
DSH050006 St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Covered Entity Details

Entity Name

St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050006

Entity Address

2700 DOLBEER STREET
EUREKA, CA 95501

Medicare Provider Number

050006

Participating Start Date

4/1/2009

Last Recertification Date

8/16/2024

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

4/20/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Mich Riccioni, CFO
(707) 445-8121 Ext: 7491

Contract Pharmacy Representative

Diplomat Specialty Pharmacy
Donna Petty, Director, Program & Account Management
(810) 768-9554

Signed By Date

4/20/2014

340B Drug Pricing Program Database