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CITY MARKET PHARMACY #404
CHC24176-02 Olathe Community Clinic, Inc.
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Covered Entity Details
Entity Name
Olathe Community Clinic, Inc.
Subdivision Name
River Family Family Health Center of Delta
Type
HRSA-Funded Health Center
340B ID
CHC24176-02
Entity Address
107 W 11th St
Delta, CO 81416
Grant Number
H80CS24176
Participating Start Date
7/1/2018
Last Recertification Date
1/31/2023
Entity Termination Date
10/1/2023
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
4/19/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeremy Carroll, CEO
(970) 263-1701
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
4/16/2018
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