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WAL-MART PHARMACY 10-5099
CHC28356-01 Marillac Clinic, Inc.
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Covered Entity Details
Entity Name
Marillac Clinic, Inc.
Subdivision Name
Marillac Clinic-County Health Department
Type
HRSA-Funded Health Center
340B ID
CHC28356-01
Entity Address
510 29 1/2 Road
Grand Junction, CO 81504-5383
Grant Number
H80CS28356
Participating Start Date
1/1/2018
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5099
Pharmacy Address
2545 RIMROCK AVE
GRAND JUNCTION (W), CO 81505
Pharmacy Comments
Contract Details
Approval Date
10/9/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kay Ramachandran, CEO
(970) 298-2235
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/9/2019
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