Contract Pharmacy Details

DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN
CH090710 COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.

Covered Entity Details

Entity Name

COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.

Subdivision Name

NIPOMO COMMUNITY MEDICAL CENTER

Type

HRSA-Funded Health Center

340B ID

CH090710

Entity Address

150 TEJAS PL
NIPOMO, CA 93444-9123

Grant Number

H80CS00621

Participating Start Date

4/1/1996

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN

Pharmacy Address

DIPLOMAT SPECIALTY PHARMACY
1809 EXCISE AVENUE
SUITE 204-208
ONTARIO, CA 91761

Pharmacy Comments

Contract Details

Approval Date

4/5/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/31/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

RONALD E. CASTLE, CEO
(805) 459-1835

Contract Pharmacy Representative

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

Signed By Date

4/5/2013

340B Drug Pricing Program Database