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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
5/8/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1492 S MILL AVE SUITE 212 ROOM P
TEMPE, AZ 85281
Pharmacy Comments
Contract Details
Approval Date
4/1/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Micaela Aida Simon, Owner/Provider
(480) 410-4128
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/1/2024
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