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UNITY RX LLC
STD850131 Your Health and Wellness PLLC
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Covered Entity Details
Entity Name
Your Health and Wellness PLLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD850131
Entity Address
635 W Glenrosa Avenue
Suite 104
Phoenix, AZ 85013
Grant Number
NU51PS005142
Participating Start Date
10/1/2023
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
UNITY RX LLC
Pharmacy Address
4515 N 16TH ST STE 105
PHOENIX, AZ 85016
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Knoblauch, Owner
(602) 625-7944
Contract Pharmacy Representative
UnityRx
Marie Vardugo, Owner
(623) 220-2121
Signed By Date
7/15/2024
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