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EXPRESS SCRIPTS
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
NU62PS924818
Participating Start Date
4/1/2022
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS
Pharmacy Address
ESI MAIL PHARMACY SERVICE INC
4600 N HANLEY RD
SAINT LOUIS, MO 63134
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Micaela Aida Simon, Owner/Provider
(480) 410-4128
Contract Pharmacy Representative
Express Scripts
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
10/4/2023
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