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CHC28356-03 Marillac Clinic, Inc. (Active)
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Main Details
Name
Marillac Clinic, Inc.
Subdivision Name
Marillac Clinic-HOMEWARD BOUND OF THE GRAND VALLEY
Type
HRSA-Funded Health Center
Site ID
BPS-H80-015038
340B ID
CHC28356-03
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
2853 NORTH AVE
GRAND JUNCTION, CO 81501-5040
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
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