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GENOA HEALTHCARE LLC
STD85282 Be Well Family Care
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Covered Entity Details
Entity Name
Be Well Family Care
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85282
Entity Address
1492 S. MILL AVE.
SUITE 212
Tempe, AZ 85281
Grant Number
NU51PS005142
Participating Start Date
4/1/2022
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1101 NORTH CENTRAL AVE
STE 102
PHOENIX, AZ 85004
Pharmacy Comments
Contract Details
Approval Date
10/3/2022
Contract Begin Date
10/17/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Micaela Aida Simon, Owner/Provider
(480) 410-4128
Contract Pharmacy Representative
Optum
Helia Pimentel, Coordinator client Services 340B-OptumRx
(714) 825-3725
Signed By Date
10/3/2022
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