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GENOA HEALTHCARE LLC
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
NU51PS005142
Participating Start Date
4/1/2024
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
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
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2024
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