Contract Pharmacy Details

SAFEWAY INC
CHC28356-03 Marillac Clinic, Inc.

Covered Entity Details

Entity Name

Marillac Clinic, Inc.

Subdivision Name

Marillac Clinic-HOMEWARD BOUND OF THE GRAND VALLEY

Type

HRSA-Funded Health Center

340B ID

CHC28356-03

Entity Address

2853 NORTH AVE
GRAND JUNCTION, CO 81501-5040

Grant Number

H80CS28356

Participating Start Date

1/1/2018

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1533
2901 F ROAD
GRAND JUNCTION, CO 81504

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

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

10/9/2019

340B Drug Pricing Program Database