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GRUBBS CARE PHARMACY NW INC.
CH037030 Mary's Center For Maternal And Child Care, Inc.
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Covered Entity Details
Entity Name
Mary's Center For Maternal And Child Care, Inc.
Subdivision Name
Adams Morgan DC
Type
HRSA-Funded Health Center
340B ID
CH037030
Entity Address
2333 Ontario Rd NW
Washington, DC 20009-2627
Grant Number
H80CS04202
Participating Start Date
7/1/2014
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
GRUBBS CARE PHARMACY NW INC.
Pharmacy Address
GRUBB'S NW SPECIALTY PHARMACY
1517 17TH ST NW FL 1
WASHINGTON, DC 20036-6230
Pharmacy Comments
Contract Details
Approval Date
10/18/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/12/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Dara Koppelman, EVP of Health Services and Programs
(202) 545-2063
Contract Pharmacy Representative
Grubb's
michael kim, president
(202) 387-2435
Signed By Date
10/18/2016
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