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MELROSE PHARMACY
STD85013 Your Health and Wellness PLLC
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Covered Entity Details
Entity Name
Your Health and Wellness PLLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85013
Entity Address
3326 N 3rd Avenue
Suite 201
Phoenix, AZ 85013
Grant Number
NU51PS005142
Participating Start Date
7/1/2023
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
MELROSE PHARMACY
Pharmacy Address
706 W. MONTECITO AVE
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
7/10/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Knoblauch, Owner
(602) 625-7944
Contract Pharmacy Representative
Melrose Pharmacy
Teresa Stickler, Owner/Rph
(602) 277-4714
Signed By Date
7/10/2023
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