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MELROSE PHARMACY
CHC33644-00 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
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Covered Entity Details
Entity Name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Subdivision Name
Valleywise Health Administrative Building
Type
HRSA-Funded Health Center
340B ID
CHC33644-00
Entity Address
2601 E Roosevelt St
Phoenix, AZ 85008
Grant Number
H80CS33644
Participating Start Date
1/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
MELROSE PHARMACY
Pharmacy Address
706 W. MONTECITO AVE
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael White, Executive Vice President, Chief Clinical Officer
(602) 344-5503
Contract Pharmacy Representative
Melrose Pharmacy
Teresa Stickler, Owner
(602) 277-4714
Signed By Date
4/15/2021
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