Covered Entity Details

STD85282 Be Well Family Care (Active) - information as of 6/24/2025 3:02:53 AM

Main Details

Name

Be Well Family Care

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD85282

Grant Number

NU62PS924818

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

In-Kind products or services (see note below; must have been purchased with section 318 funds)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.
database, condoms, testing supplies for HIV, Hep C and STI hiv prevention
5/1/2021

Additional Details

Current Program Status

Active

Registration Date

1/3/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/31/2022

Last Recertification Date

5/5/2025

Notice of Funding Opportunity (NOFO) Number

PS24-0047

Contacts

Authorizing Official

Be Well Family Care
Micaela Aida Simon, Owner/Provider
(480) 410-4128

Primary Contact

Be Well Family Care
Julia A Kieffer, Family Nurse Practitioner
(480) 410-4128

Addresses

Street Address

1492 S. MILL AVE.
SUITE 212
Tempe, AZ 85281

Billing Address

Be Well Family Care
7000 N. 16th Pl
#120-228
Phoenix, AZ 85020

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
AZ		1225660111

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/17/2023	10/01/2023		10/01/2023
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/17/2023	10/01/2023		10/01/2023
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/17/2023	10/01/2023		10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/17/2023	10/01/2023		10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/17/2023	10/01/2023		10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/17/2023	10/01/2023		10/01/2023
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/13/2024	07/01/2024		07/01/2024
Contract Detail	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09347	1525 NORTH CENTRAL AVENUE	PHOENIX	AZ	85004	10/04/2023	01/01/2024		01/01/2024
Contract Detail	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09314	3440 WEST GLENDALE AVE	PHOENIX	AZ	85051	04/01/2025	07/01/2025		04/01/2025
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/15/2022	05/16/2022		05/16/2022
Contract Detail	CAREMARK ILLINOIS MAIL PHARMACY, LLC	DBA CVS/CAREMARK OR CARELONRX MAIL #8702	800 BIERMANN COURT SUITE A	MOUNT PROSPECT	IL	60056	04/15/2022	05/16/2022	04/10/2023	04/10/2023
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/10/2023	05/05/2023		05/05/2023
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/15/2022	05/16/2022		05/16/2022
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/15/2022	05/16/2022		05/16/2022
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/15/2022	05/16/2022		05/16/2022
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/15/2022	05/16/2022		05/16/2022
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/05/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/15/2022	05/16/2022		05/16/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/15/2022	05/16/2022		05/16/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/15/2022	05/16/2022		05/16/2022
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/15/2023	04/01/2023		04/01/2023
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/15/2023	04/01/2023		04/01/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/15/2022	05/16/2022		05/16/2022
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/16/2023	04/01/2023		04/01/2023
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/12/2023	01/01/2024		01/01/2024
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/04/2023	01/01/2024		01/01/2024
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/04/2023	01/01/2024		01/01/2024
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/04/2023	01/01/2024		01/01/2024
Contract Detail	GENOA HEALTHCARE LLC	1101 NORTH CENTRAL AVE	STE 102	PHOENIX	AZ	85004	10/03/2022	10/17/2022		10/17/2022
Contract Detail	GENOA HEALTHCARE LLC	1492 S MILL AVE SUITE 212 ROOM P		TEMPE	AZ	85281	04/01/2024	07/01/2024		07/01/2024
Contract Detail	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 09205	802 S. MILL AVE.	TEMPE	AZ	85281	04/15/2022	05/16/2022		05/16/2022
Contract Detail	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 00040	1424 W BASELINE RD	TEMPE	AZ	85283	04/15/2022	05/16/2022	06/14/2023	06/14/2023
Contract Detail	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 05950	855 E. ELLIOT ROAD	TEMPE	AZ	85284	04/15/2022	05/16/2022		05/16/2022
Contract Detail	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 07078	3303 S. RURAL	TEMPE	AZ	85282	04/15/2022	05/16/2022	07/20/2023	07/20/2023
Contract Detail	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10928	909 EAST APACHE BLVD	TEMPE	AZ	85281	04/15/2022	05/16/2022		05/16/2022
Contract Detail	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 17256	1800 E RIO SALADO PKWY STE 120	TEMPE	AZ	85281	04/15/2022	05/16/2022		05/16/2022
Contract Detail	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 00033	1750 E BROADWAY RD	TEMPE	AZ	85282	04/15/2022	05/16/2022		05/16/2022
Contract Detail	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16110	1818 E BASELINE RD	TEMPE	AZ	85283	04/15/2022	05/16/2022		05/16/2022
Contract Detail	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16366	4515 E THOMAS RD	PHOENIX	AZ	85018	07/11/2024	10/01/2024		10/01/2024
Contract Detail	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 03143	990 E. WARNER RD.	CHANDLER	AZ	85225	04/01/2025	07/01/2025		04/01/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/15/2022	05/16/2022		05/16/2022
Contract Detail	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	04/15/2022	05/16/2022		05/16/2022
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/15/2022	05/16/2022		05/16/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/15/2022	05/16/2022		05/16/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #3129	1002 EAST MCDOWELL ROAD	PHOENIX	AZ	85006	04/15/2022	05/16/2022		05/16/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/15/2022	05/16/2022		05/16/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/15/2022	05/16/2022		05/16/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/15/2022	05/16/2022		05/16/2022
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/16/2024	04/01/2024		04/01/2024
Contract Detail	WAL-MART PHARMACY 10-3799	240 WEST BASELINE ROAD		MESA	AZ	85210	01/16/2024	04/01/2024		04/01/2024
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/16/2024	04/01/2024		04/01/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/16/2024	04/01/2024		04/01/2024
Contract Detail	WALGREEN ARIZONA DRUG CO.	WALGREENS SPECIALTY PHARMACY #16431	2302 N. CENTRAL AVE. SUITE 7	PHOENIX	AZ	85004	01/31/2022	04/01/2022		04/01/2022
Contract Detail	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 01197	1745 E SOUTHERN AVE	TEMPE	AZ	85282-7625	01/15/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 06784	2024 W MAIN STREET	MESA	AZ	85201-6802	01/15/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 11610	2000 S. MILL AVE.	TEMPE	AZ	85282	01/15/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 03727	1919 N DOBSON RD	CHANDLER	AZ	85224	01/15/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 03464	3402 N CENTRAL AVE	PHOENIX	AZ	85012	07/10/2023	10/01/2023		10/01/2023
Contract Detail	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	10/04/2023	01/01/2024		01/01/2024
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21215	309C 22ND AVE N	NASHVILLE	TN	37203	01/02/2024	04/01/2024		04/01/2024
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15317	1424 UNION AVE	MEMPHIS	TN	38104	04/01/2024	07/01/2024		07/01/2024
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16403	1409 11TH AVE.	SEATTLE	WA	98122	10/04/2024	01/01/2025		01/01/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/15/2023	04/01/2023		04/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/15/2023	04/01/2023		04/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/15/2023	04/01/2023		04/01/2023
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/16/2024	04/01/2024		04/01/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/16/2024	04/01/2024		04/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Nature of Support: In Kind Support Description	Update	Change Request	database, condoms, testing supplies	database, condoms, testing supplies for HIV, Hep C and STI hiv prevention	5/21/2025 6:29 AM
Details	Grant Number	Update	Change Request	NU51PS005142	NU62PS924818	5/21/2025 6:29 AM
Details	NOFO Number	Update	Change Request	PS21-2103	PS24-0047	5/21/2025 6:29 AM
Details	Last Recertification Date	Update	Recertification	5/8/2024 7:40:00 PM	5/5/2025 1:42:55 PM	5/5/2025 1:42 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1225660111	3/11/2025 10:39 AM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	3/11/2025 10:39 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	004856 (AZ)		10/8/2024 11:20 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1225660111 (AZ)		10/8/2024 11:20 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/2/2024 11:22 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		004856	7/2/2024 11:22 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	7/2/2024 11:22 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1225660111	7/2/2024 11:22 AM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	7/2/2024 11:22 AM
Details	Last Recertification Date	Update	Recertification	5/10/2023 10:27:39 AM	5/8/2024 7:40:00 PM	5/8/2024 7:40 PM
Details	Last Recertification Date	Update	Recertification	5/11/2022 3:54:10 PM	5/10/2023 10:27:39 AM	5/10/2023 10:27 AM
Details	Last Recertification Date	Update	Recertification		5/11/2022 3:54:10 PM	5/11/2022 3:54 PM
Addresses	Main Address	Update	Change Request	1845 E. Broadway Rd 116 Tempe, AZ 85282	1492 S. MILL AVE. SUITE 212 Tempe, AZ 85281	5/2/2022 11:12 AM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Simon, Micaela Aida Owner/Provider Be Well Family Care 4804104128	1/31/2022 7:15 AM
Details	340B ID	Update	New Registration		STD85282	1/31/2022 7:15 AM
Dates	Participating Approval Date	Update	New Registration		1/31/2022 7:15:34 AM	1/31/2022 7:15 AM
Details	State	Update	New Registration	Pending	Approved	1/31/2022 7:15 AM
Dates	Signed By Date	Update	New Registration		1/3/2022 11:00:49 AM	1/31/2022 7:15 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/31/2022 7:15 AM
Addresses	Main Address	Insert	New Registration		1845 E. Broadway Rd 116 Tempe, AZ 85282	1/3/2022 11:00 AM
Addresses	Billing Address	Insert	New Registration		Be Well Family Care 7000 N. 16th Pl #120-228 Phoenix, AZ 85020	1/3/2022 11:00 AM
Details	Nature of Support: In Kind Support Description	Insert	New Registration		database, condoms, testing supplies	1/3/2022 11:00 AM
Details	Nature Of Support	Insert	New Registration		In-Kind products or services (see note below; must have been purchased with section 318 funds)	1/3/2022 11:00 AM
Details	Nature of Support: Support Received From Date	Insert	New Registration		5/1/2021 12:00:00 AM	1/3/2022 11:00 AM
Details	Nature of Support: Support Received To Date	Insert	New Registration			1/3/2022 11:00 AM
Contacts	Authorizing Official	Insert	New Registration		Simon, Micaela Aida Owner/Provider Be Well Family Care 4804104128	1/3/2022 11:00 AM
Contacts	Primary Contact	Insert	New Registration		Kieffer, Julia A Family Nurse Practitioner Be Well Family Care 4804104128	1/3/2022 11:00 AM
Details	Assistance Received From Date	Insert	New Registration			1/3/2022 11:00 AM
Details	Assistance Received To Date	Insert	New Registration			1/3/2022 11:00 AM
Details	Last Recertification Date	Insert	New Registration			1/3/2022 11:00 AM
Details	Grant Number	Insert	New Registration		NU51PS005142	1/3/2022 11:00 AM
Details	340B ID	Insert	New Registration			1/3/2022 11:00 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/3/2022 11:00 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/3/2022 11:00 AM
Details	Medicare Provider Number	Insert	New Registration			1/3/2022 11:00 AM
Details	Entity Name	Insert	New Registration		Be Well Family Care	1/3/2022 11:00 AM
Details	NOFO Number	Insert	New Registration		PS21-2103	1/3/2022 11:00 AM
Details	Program Code	Insert	New Registration		STD	1/3/2022 11:00 AM
Details	Entity Subname	Insert	New Registration			1/3/2022 11:00 AM
Dates	Participating Approval Date	Insert	New Registration			1/3/2022 11:00 AM
Details	State	Insert	New Registration		Pending	1/3/2022 11:00 AM
Dates	Registration Date	Insert	New Registration		1/3/2022 11:00:45 AM	1/3/2022 11:00 AM
Dates	Signed By Date	Insert	New Registration			1/3/2022 11:00 AM
Dates	Start Date	Insert	New Registration			1/3/2022 11:00 AM
Terminations	Termination Comments	Insert	New Registration			1/3/2022 11:00 AM
Terminations	Termination Date	Insert	New Registration			1/3/2022 11:00 AM
Terminations	Termination Effective Date	Insert	New Registration			1/3/2022 11:00 AM
Terminations	Termination Reason	Insert	New Registration			1/3/2022 11:00 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History