Contract Pharmacy Details

CITY MARKET PHARMACY #25
CHC28356-00 MARILLAC CLINIC, INC.

Covered Entity Details

Entity Name

MARILLAC CLINIC, INC.

Subdivision Name

Marillac Clinic-Grand Junction

Type

HRSA-Funded Health Center

340B ID

CHC28356-00

Entity Address

2333 N 6TH ST
GRAND JUNCTION, CO 81501-2001

Grant Number

H80CS28356

Participating Start Date

10/1/2017

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

CITY MARKET PHARMACY #25

Pharmacy Address

569 32 ROAD
GRAND JUNCTION, CO 81504

Pharmacy Comments

Contract Details

Approval Date

10/14/2019

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

Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875

Signed By Date

10/14/2019

340B Drug Pricing Program Database