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WAL-MART PHARMACY 10-1058
CHC28356-00 MARILLAC CLINIC, INC.
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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
WAL-MART PHARMACY 10-1058
Pharmacy Address
16750 S. TOWNSEND
MONTROSE, CO 81401
Pharmacy Comments
Contract Details
Approval Date
4/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kay Ramachandran, CEO
(970) 200-1629
Contract Pharmacy Representative
Freedom Advising
Jeremy John Carroll, CFO
(832) 443-7395
Signed By Date
4/10/2024
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