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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16403
1409 11TH AVE.
SEATTLE, WA 98122
Pharmacy Comments
Contract Details
Approval Date
10/4/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Micaela Aida Simon, Owner/Provider
(480) 410-4128
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/4/2024
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