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MELROSE PHARMACY
STD85004 Prisma Community Care
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Covered Entity Details
Entity Name
Prisma Community Care
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85004
Entity Address
1101 N Central Ave
Suite 200
Phoenix, AZ 85004
Grant Number
5 NU62PS924676-03-00
Participating Start Date
1/1/2019
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
MELROSE PHARMACY
Pharmacy Address
706 W. MONTECITO AVE
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
4/3/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jessyca Leach, Chief Executive Officer
(602) 595-8115
Contract Pharmacy Representative
Melrose Pharmacy
Teresa Stickler, Owner/Rph
(602) 277-4714
Signed By Date
4/3/2025
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