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CYSTIC FIBROSIS SERVICES, LLC
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
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kay Ramachandran, CEO
(970) 298-2235
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2017
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