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