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ARIZONA CVS STORES, L.L.C.
STD850122 Be Well Family Care
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Covered Entity Details
Entity Name
Be Well Family Care
Subdivision Name
Be Well Health
Type
Sexually Transmitted Diseases
340B ID
STD850122
Entity Address
3402 N. CENTRAL AVE
PHOENIX, AZ 85012
Grant Number
NU62PS924818
Participating Start Date
4/1/2024
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
ARIZONA CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09347
1525 NORTH CENTRAL AVENUE
PHOENIX, AZ 85004
Pharmacy Comments
Contract Details
Approval Date
4/13/2024
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2024
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