Covered Entity Details

CHC28356-04 Marillac Clinic, Inc. (Active) - information as of 6/9/2025 11:03:35 PM

Main Details

Name

Marillac Clinic, Inc.

Subdivision Name

Marillac Clinic - Primary Care Partners

Type

HRSA-Funded Health Center

Site ID

BPS-H80-015052

340B ID

CHC28356-04

Grant Number

H80CS28356

Additional Details

Current Program Status

Active

Registration Date

11/1/2017

Participating Start Date

1/1/2018

Participating Approval Date

11/6/2017

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

Marillac Clinic Inc
Kay Ramachandran, CEO
(970) 200-1629

Primary Contact

Freedom Advising
Jeremy John Carroll, CFO
(832) 443-7395

Addresses

Street Address

3150 N 12TH ST
GRAND JUNCTION, CO 81506-2863

Billing Address

Marillac Clinic, Inc.
2333 N6th St
Grand Junction, CO 81501

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

Marillac Clinic, Inc.
2333 N 6th Street
Grand Junction, CO 81501

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CITY MARKET PHARMACY #25	569 32 ROAD		GRAND JUNCTION	CO	81504	10/14/2019	01/01/2020		01/01/2020
Contract Detail	CITY MARKET PHARMACY #401	2770 HWY 50 SOUTH		GRAND JUNCTION	CO	81503	10/14/2019	01/01/2020		01/01/2020
Contract Detail	CITY MARKET PHARMACY #444	2600 NORTH 12TH ST		GRAND JUNCTION	CO	81501	10/14/2019	01/01/2020		01/01/2020
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1533	2901 F ROAD	GRAND JUNCTION	CO	81504	10/09/2019	01/01/2020		01/01/2020
Contract Detail	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	10/14/2019	01/01/2020		01/01/2020
Contract Detail	THRIFTY PAYLESS INC.	RITE AID #6178	1834 NORTH 12TH STREET	GRAND JUNCTION	CO	81501	10/09/2019	01/01/2020	10/21/2020	07/06/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/09/2019	01/01/2020		01/01/2020
Contract Detail	WAL-MART PHARMACY 10-1280	2881 NORTH AVENUE		GRAND JUNCTION	CO	81501	10/09/2019	01/01/2020		01/01/2020
Contract Detail	WAL-MART PHARMACY 10-5099	2545 RIMROCK AVE		GRAND JUNCTION (W)	CO	81505	10/09/2019	01/01/2020		01/01/2020
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/09/2019	01/01/2020		01/01/2020
Contract Detail	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	01/15/2025	04/01/2025		04/01/2025
Contract Detail	WALMART PHARMACY 10-4491	541 WARRIOR WAY		GRAND JUNCTION	CO	81504	10/09/2019	01/01/2020		01/01/2020

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC28356-00	Active	BPS-H80-015058	MARILLAC CLINIC, INC.	Marillac Clinic-Grand Junction	2333 N 6TH ST	GRAND JUNCTION	CO
CHC28356-01	Active	BPS-H80-015053	Marillac Clinic, Inc.	Marillac Clinic-County Health Department	510 29 1/2 Road	Grand Junction	CO
CHC28356-02	Active	BPS-H80-015056	Marillac Clinic, Inc.	Marillac Clinic-OUTREACH DAY CENTER	302 PITKIN AVE	GRAND JUNCTION	CO
CHC28356-03	Active	BPS-H80-015038	Marillac Clinic, Inc.	Marillac Clinic-HOMEWARD BOUND OF THE GRAND VALLEY	2853 NORTH AVE	GRAND JUNCTION	CO
CHC28356-04	Active	BPS-H80-015052	Marillac Clinic, Inc.	Marillac Clinic - Primary Care Partners	3150 N 12TH ST	GRAND JUNCTION	CO

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC28356-00	ALBERTSONS LLC	SAFEWAY PHARMACY # 897	2512 BROADWAY	GRAND JUNCTION	CO	81507	07/01/2024
CHC28356-00	CITY MARKET PHARMACY	16400 S. TOWNSEND		MONTROSE	CO	81401	07/01/2024
CHC28356-00	CITY MARKET PHARMACY #13	135 SOUTH PLUM		FRUITA	CO	81521	07/01/2024
CHC28356-00	CITY MARKET PHARMACY #25	569 32 ROAD		GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-01	CITY MARKET PHARMACY #25	569 32 ROAD		GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-03	CITY MARKET PHARMACY #25	569 32 ROAD		GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-02	CITY MARKET PHARMACY #25	569 32 ROAD		GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-04	CITY MARKET PHARMACY #25	569 32 ROAD		GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-00	CITY MARKET PHARMACY #3	128 SOUTH TOWNSEND	PO BOX 608	MONTROSE	CO	81401	07/01/2024
CHC28356-04	CITY MARKET PHARMACY #401	2770 HWY 50 SOUTH		GRAND JUNCTION	CO	81503	01/01/2020
CHC28356-01	CITY MARKET PHARMACY #401	2770 HWY 50 SOUTH		GRAND JUNCTION	CO	81503	01/01/2020
CHC28356-02	CITY MARKET PHARMACY #401	2770 HWY 50 SOUTH		GRAND JUNCTION	CO	81503	01/01/2020
CHC28356-00	CITY MARKET PHARMACY #401	2770 HWY 50 SOUTH		GRAND JUNCTION	CO	81503	01/01/2020
CHC28356-03	CITY MARKET PHARMACY #401	2770 HWY 50 SOUTH		GRAND JUNCTION	CO	81503	01/01/2020
CHC28356-01	CITY MARKET PHARMACY #444	2600 NORTH 12TH ST		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-04	CITY MARKET PHARMACY #444	2600 NORTH 12TH ST		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-00	CITY MARKET PHARMACY #444	2600 NORTH 12TH ST		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-02	CITY MARKET PHARMACY #444	2600 NORTH 12TH ST		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-03	CITY MARKET PHARMACY #444	2600 NORTH 12TH ST		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-00	CITY MARKET PHARMACY #451	630 24 ROAD		GRAND JUNCTION	CO	81505	07/01/2024
CHC28356-00	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/01/2018
CHC28356-00	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/01/2018
CHC28356-00	RXPLUS LIMITED PALISADE, LLC	DBA PALISADE PHARMACY	707 ELBERTA AVE UNIT B	PALISADE	CO	81526-8806	07/01/2024
CHC28356-04	SAFEWAY INC	SAFEWAY PHARMACY #1533	2901 F ROAD	GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-00	SAFEWAY INC	SAFEWAY PHARMACY #1533	2901 F ROAD	GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-01	SAFEWAY INC	SAFEWAY PHARMACY #1533	2901 F ROAD	GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-02	SAFEWAY INC	SAFEWAY PHARMACY #1533	2901 F ROAD	GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-03	SAFEWAY INC	SAFEWAY PHARMACY #1533	2901 F ROAD	GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-00	SAFEWAY INC	SAFEWAY PHARMACY #1131	1329 S. TOWNSEND AVENUE	MONTROSE	CO	81401	07/01/2024
CHC28356-00	SAFEWAY INC	SAFEWAY PHARMACY #2625	681 HORIZON DRIVE	GRAND JUNCTION	CO	81506	07/01/2024
CHC28356-00	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	01/01/2020
CHC28356-02	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	01/01/2020
CHC28356-03	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	01/01/2020
CHC28356-04	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	01/01/2020
CHC28356-01	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	01/01/2020
CHC28356-04	THRIFTY PAYLESS INC.	RITE AID #6178	1834 NORTH 12TH STREET	GRAND JUNCTION	CO	81501	01/01/2020	10/21/2020
CHC28356-03	THRIFTY PAYLESS INC.	RITE AID #6178	1834 NORTH 12TH STREET	GRAND JUNCTION	CO	81501	01/01/2020	10/21/2020
CHC28356-00	THRIFTY PAYLESS INC.	RITE AID #6178	1834 NORTH 12TH STREET	GRAND JUNCTION	CO	81501	01/01/2020	10/21/2020
CHC28356-02	THRIFTY PAYLESS INC.	RITE AID #6178	1834 NORTH 12TH STREET	GRAND JUNCTION	CO	81501	01/01/2020	10/21/2020
CHC28356-01	THRIFTY PAYLESS INC.	RITE AID #6178	1834 NORTH 12TH STREET	GRAND JUNCTION	CO	81501	01/01/2020	10/21/2020
CHC28356-02	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CHC28356-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CHC28356-03	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CHC28356-01	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CHC28356-04	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CHC28356-00	WAL-MART PHARMACY 10-1058	16750 S. TOWNSEND		MONTROSE	CO	81401	07/01/2024
CHC28356-00	WAL-MART PHARMACY 10-1280	2881 NORTH AVENUE		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-03	WAL-MART PHARMACY 10-1280	2881 NORTH AVENUE		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-01	WAL-MART PHARMACY 10-1280	2881 NORTH AVENUE		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-04	WAL-MART PHARMACY 10-1280	2881 NORTH AVENUE		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-02	WAL-MART PHARMACY 10-1280	2881 NORTH AVENUE		GRAND JUNCTION	CO	81501	01/01/2020
CHC28356-01	WAL-MART PHARMACY 10-5099	2545 RIMROCK AVE		GRAND JUNCTION (W)	CO	81505	01/01/2020
CHC28356-04	WAL-MART PHARMACY 10-5099	2545 RIMROCK AVE		GRAND JUNCTION (W)	CO	81505	01/01/2020
CHC28356-00	WAL-MART PHARMACY 10-5099	2545 RIMROCK AVE		GRAND JUNCTION (W)	CO	81505	01/01/2020
CHC28356-02	WAL-MART PHARMACY 10-5099	2545 RIMROCK AVE		GRAND JUNCTION (W)	CO	81505	01/01/2020
CHC28356-03	WAL-MART PHARMACY 10-5099	2545 RIMROCK AVE		GRAND JUNCTION (W)	CO	81505	01/01/2020
CHC28356-03	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CHC28356-04	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CHC28356-02	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CHC28356-01	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CHC28356-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CHC28356-00	WALGREEN CO	DBA: WALGREENS #11187	316 W. ASPEN AVE.	FRUITA	CO	81521	04/01/2018
CHC28356-01	WALGREEN CO	DBA: WALGREENS #11187	316 W. ASPEN AVE.	FRUITA	CO	81521	04/01/2018
CHC28356-02	WALGREEN CO	DBA: WALGREENS #11187	316 W. ASPEN AVE.	FRUITA	CO	81521	04/01/2018
CHC28356-03	WALGREEN CO	DBA: WALGREENS #11187	316 W. ASPEN AVE.	FRUITA	CO	81521	04/01/2018
CHC28356-00	WALGREEN CO.	DBA: WALGREENS # 09769	2900 NORTH AVENUE	GRAND JUNCTION	CO	81504-5315	01/01/2018
CHC28356-00	WALGREEN CO.	DBA: WALGREENS #10307	240 W PARK DRIVE	GRAND JUNCTION	CO	81505-1450	01/01/2018
CHC28356-00	WALGREEN CO.	DBA: WALGREENS # 06108	572 32 ROAD	CLIFTON	CO	81520-7606	04/01/2018
CHC28356-01	WALGREEN CO.	DBA: WALGREENS # 09769	2900 NORTH AVENUE	GRAND JUNCTION	CO	81504-5315	04/01/2018
CHC28356-01	WALGREEN CO.	DBA: WALGREENS #10307	240 W PARK DRIVE	GRAND JUNCTION	CO	81505-1450	04/01/2018
CHC28356-01	WALGREEN CO.	DBA: WALGREENS # 06108	572 32 ROAD	CLIFTON	CO	81520-7606	04/01/2018
CHC28356-02	WALGREEN CO.	DBA: WALGREENS # 09769	2900 NORTH AVENUE	GRAND JUNCTION	CO	81504-5315	04/01/2018
CHC28356-02	WALGREEN CO.	DBA: WALGREENS #10307	240 W PARK DRIVE	GRAND JUNCTION	CO	81505-1450	04/01/2018
CHC28356-02	WALGREEN CO.	DBA: WALGREENS # 06108	572 32 ROAD	CLIFTON	CO	81520-7606	04/01/2018
CHC28356-03	WALGREEN CO.	DBA: WALGREENS #10307	240 W PARK DRIVE	GRAND JUNCTION	CO	81505-1450	04/01/2018
CHC28356-03	WALGREEN CO.	DBA: WALGREENS # 06108	572 32 ROAD	CLIFTON	CO	81520-7606	04/01/2018
CHC28356-03	WALGREEN CO.	DBA: WALGREENS # 09769	2900 NORTH AVENUE	GRAND JUNCTION	CO	81504-5315	04/01/2018
CHC28356-04	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	04/01/2025
CHC28356-02	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	04/01/2025
CHC28356-00	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	04/01/2025
CHC28356-01	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	04/01/2025
CHC28356-00	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018
CHC28356-00	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/01/2018	10/01/2021
CHC28356-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2018
CHC28356-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2018
CHC28356-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2018
CHC28356-00	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018
CHC28356-01	WALMART PHARMACY 10-4491	541 WARRIOR WAY		GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-02	WALMART PHARMACY 10-4491	541 WARRIOR WAY		GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-04	WALMART PHARMACY 10-4491	541 WARRIOR WAY		GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-03	WALMART PHARMACY 10-4491	541 WARRIOR WAY		GRAND JUNCTION	CO	81504	01/01/2020
CHC28356-00	WALMART PHARMACY 10-4491	541 WARRIOR WAY		GRAND JUNCTION	CO	81504	01/01/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/20/2024 12:35:21 PM	2/13/2025 12:06:31 PM	2/13/2025 12:06 PM
Contacts	Primary Contact	Update	PC Change Request	Becker, Daniel Brian CFO Marillac Clinic Inc 9704244899	Carroll, Jeremy John CFO Freedom Advising 8324437395	2/20/2024 1:03 PM
Details	Last Recertification Date	Update	Recertification	2/3/2023 3:40:33 PM	2/20/2024 12:35:21 PM	2/20/2024 12:35 PM
Details	Last Recertification Date	Update	Recertification	2/2/2022 5:24:13 PM	2/3/2023 3:40:33 PM	2/3/2023 3:40 PM
Contacts	Primary Contact	Update	Profile Change Request	Becker, Daniel Brian CFO Marillac Clinic Inc 9702001625	Becker, Daniel Brian CFO Marillac Clinic Inc 9704244899	2/21/2022 8:27 AM
Details	Last Recertification Date	Update	Recertification	2/3/2021 5:41:39 PM	2/2/2022 5:24:13 PM	2/2/2022 5:24 PM
Contacts	Primary Contact	Update	Group Change Request	Becker, Daniel Brian CFO Marillac Clinic, Inc. 9702001625	Becker, Daniel Brian CFO Marillac Clinic Inc 9702001625	7/6/2021 7:53 AM
Contacts	Authorizing Official	Update	AO Change Request	Ramachandran, Kay CEO Marillac Clinic, Inc. 9702982235	Ramachandran, Kay CEO Marillac Clinic Inc 9702001629	6/25/2021 6:54 AM
Details	Last Recertification Date	Update	Recertification	1/27/2020 1:51:15 PM	2/3/2021 5:41:39 PM	2/3/2021 5:41 PM
Contacts	Primary Contact	Update	Profile Change Request	Becker, Daniel Brian CFO Marillac Clinic, Inc. 9702981799	Becker, Daniel Brian CFO Marillac Clinic, Inc. 9702001625	9/29/2020 9:40 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 6:13:44 PM	1/27/2020 1:51:15 PM	1/27/2020 1:51 PM
Details	Last Recertification Date	Update	Recertification	2/9/2018 5:56:10 PM	1/30/2019 6:13:44 PM	1/30/2019 6:13 PM
Addresses	Billing Address	Insert	Change Request		Marillac Clinic, Inc. 2333 N6th St Grand Junction, CO 81501	4/30/2018 2:52 PM
Addresses	Shipping Address	Insert	Change Request		Marillac Clinic, Inc. 2333 N 6th Street Grand Junction, CO 81501	4/30/2018 2:52 PM
Details	Last Recertification Date	Update	Recertification		2/9/2018 5:56:10 PM	2/9/2018 5:56 PM
Details	State	Update		Approved	Active	1/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Ramachandran, Kay CEO Marillac Clinic, Inc. 9702982235	11/6/2017 2:52 PM
Details	340B ID	Update	New Registration		CHC28356-04	11/6/2017 2:52 PM
Dates	Participating Approval Date	Update	New Registration		11/6/2017 2:52:47 PM	11/6/2017 2:52 PM
Details	State	Update	New Registration	Pending	Approved	11/6/2017 2:52 PM
Dates	Signed By Date	Update	New Registration		11/1/2017 12:15:51 PM	11/6/2017 2:52 PM
Dates	Start Date	Update	New Registration		1/1/2018 12:00:00 AM	11/6/2017 2:52 PM
Addresses	Main Address	Insert	New Registration		3150 N 12TH ST GRAND JUNCTION, CO 81506-2863	11/1/2017 12:15 PM
Contacts	Authorizing Official	Insert	New Registration		Ramachandran, Kay CEO Marillac Clinic, Inc. 9702982235	11/1/2017 12:15 PM
Contacts	Primary Contact	Insert	New Registration		Becker, Daniel Brian CFO Marillac Clinic, Inc. 9702981799	11/1/2017 12:15 PM
Details	Last Recertification Date	Insert	New Registration			11/1/2017 12:15 PM
Details	Grant Number	Insert	New Registration		H80CS28356	11/1/2017 12:15 PM
Details	340B ID	Insert	New Registration			11/1/2017 12:15 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			11/1/2017 12:15 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			11/1/2017 12:15 PM
Details	Medicare Provider Number	Insert	New Registration			11/1/2017 12:15 PM
Details	Entity Name	Insert	New Registration		Marillac Clinic, Inc.	11/1/2017 12:15 PM
Details	Program Code	Insert	New Registration		CH	11/1/2017 12:15 PM
Details	Entity Subname	Insert	New Registration		Marillac Clinic - Primary Care Partners	11/1/2017 12:15 PM
Dates	Participating Approval Date	Insert	New Registration			11/1/2017 12:15 PM
Details	State	Insert	New Registration		Pending	11/1/2017 12:15 PM
Dates	Registration Date	Insert	New Registration		11/1/2017 12:15:48 PM	11/1/2017 12:15 PM
Dates	Signed By Date	Insert	New Registration			11/1/2017 12:15 PM
Dates	Start Date	Insert	New Registration			11/1/2017 12:15 PM
Terminations	Termination Comments	Insert	New Registration			11/1/2017 12:15 PM
Terminations	Termination Date	Insert	New Registration			11/1/2017 12:15 PM
Terminations	Termination Effective Date	Insert	New Registration			11/1/2017 12:15 PM
Terminations	Termination Reason	Insert	New Registration			11/1/2017 12:15 PM

340B Drug Pricing Program Database