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Walgreens #21397
CHC28356-01 Marillac Clinic, Inc.
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Covered Entity Details
Entity Name
Marillac Clinic, Inc.
Subdivision Name
Marillac Clinic-County Health Department
Type
HRSA-Funded Health Center
340B ID
CHC28356-01
Entity Address
510 29 1/2 Road
Grand Junction, CO 81504-5383
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
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