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CITY MARKET PHARMACY #25
CHC28356-04 Marillac Clinic, Inc.
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Covered Entity Details
Entity Name
Marillac Clinic, Inc.
Subdivision Name
Marillac Clinic - Primary Care Partners
Type
HRSA-Funded Health Center
340B ID
CHC28356-04
Entity Address
3150 N 12TH ST
GRAND JUNCTION, CO 81506-2863
Grant Number
H80CS28356
Participating Start Date
1/1/2018
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
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