Contract Pharmacy Details

Walgreens #21397
CHC28356-02 Marillac Clinic, Inc.

Covered Entity Details

Entity Name

Marillac Clinic, Inc.

Subdivision Name

Marillac Clinic-OUTREACH DAY CENTER

Type

HRSA-Funded Health Center

340B ID

CHC28356-02

Entity Address

302 PITKIN AVE
GRAND JUNCTION, CO 81501-2415

Grant Number

H80CS28356

Participating Start Date

1/1/2018

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

Walgreens #21397

Pharmacy Address

Walgreens Central Fill #21397
5675 Pecos St.
Suite 100
Denver, CO 80221-6655

Pharmacy Comments

Contract Details

Approval Date

1/15/2025

Contract Begin Date

4/1/2025

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

1/15/2025

340B Drug Pricing Program Database