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CITY MARKET PHARMACY #404
HV00593 St. Mary's Hospital & Medical Center, Inc.
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Covered Entity Details
Entity Name
St. Mary's Hospital & Medical Center, Inc.
Subdivision Name
Ryan White Part C HIV Clinic
Type
Ryan White Part C
340B ID
HV00593
Entity Address
2698 Patterson Road
Grand Junction, CO 81506
Grant Number
H76HA00593
Participating Start Date
10/1/2012
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
CITY MARKET PHARMACY #404
Pharmacy Address
PHARMACY DEPARTMENT
122 GUNNISON RIVER DRIVE
DELTA, CO 81416
Pharmacy Comments
Contract Details
Approval Date
1/14/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/19/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kristy Watkins, Program Director
(970) 298-1702
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/14/2016
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