Contract Pharmacy Details

CITY MARKET PHARMACY #404
CHC24176-03 Olathe Community Clinic, Inc.

Covered Entity Details

Entity Name

Olathe Community Clinic, Inc.

Subdivision Name

River Valley Family Health Center of Montrose

Type

HRSA-Funded Health Center

340B ID

CHC24176-03

Entity Address

1010 Rio Grande Avenue
Montrose, CO 81401

Grant Number

H80CS24176

Participating Start Date

7/1/2018

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

CITY MARKET PHARMACY #404

Pharmacy Address

PHARMACY DEPARTMENT
122 GUNNISON RIVER DRIVE
DELTA, CO 81416

Pharmacy Comments

Contract Details

Approval Date

7/16/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeremy Carroll, CEO
(970) 263-1701

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

7/16/2018

340B Drug Pricing Program Database