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WAL-MART PHARMACY 10-5315
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
5/8/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/13/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Micaela Aida Simon, Owner/Provider
(480) 410-4128
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2024
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