Contract Pharmacy Details

WALGREEN CO
CHC28356-03 Marillac Clinic, Inc.

Covered Entity Details

Entity Name

Marillac Clinic, Inc.

Subdivision Name

Marillac Clinic-HOMEWARD BOUND OF THE GRAND VALLEY

Type

HRSA-Funded Health Center

340B ID

CHC28356-03

Entity Address

2853 NORTH AVE
GRAND JUNCTION, CO 81501-5040

Grant Number

H80CS28356

Participating Start Date

1/1/2018

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #11187
316 W. ASPEN AVE.
FRUITA, CO 81521

Pharmacy Comments

Contract Details

Approval Date

1/24/2018

Contract Begin Date

4/1/2018

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

1/24/2018

340B Drug Pricing Program Database