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THE KROGER CO., KS 113
CHC28356-03 Marillac Clinic, Inc.
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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
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
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
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