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DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN
DSH500015 MULTICARE AUBURN MEDICAL CENTER
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Covered Entity Details
Entity Name
MULTICARE AUBURN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500015
Entity Address
202 NORTH DIVISION STREET
AUBURN, WA 98001
Medicare Provider Number
500015
Participating Start Date
1/1/2015
Last Recertification Date
8/18/2024
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
1/5/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Diplomat
Sandra Barbosa, Pharmacy Manager
(602) 366-4692
Signed By Date
1/5/2017
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