340B Drug Pricing Program Database


STD891012 Sagebrush Health Services (Terminated) - information as of 5/13/2025 1:43:25 AM

Main Details
Sagebrush Health Services
Bonanza Clinic
Sexually Transmitted Diseases
STD891012
6 NH25PS005179-03-05


In-Kind products or services (see note below; must have been purchased with section 318 funds)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.
The in-kind donation we received from the Nevada Department of Health and Human Services is condoms.
1/1/2019 - 12/31/2023


Additional Details
Terminated
10/14/2021
1/1/2022
11/3/2021
6/6/2022
PS19-1901

7/1/2023
Other

Contacts

Sagebrush Health Services
Jami Dybik, Vice President
(843) 814-5177

Sagebrush Health
Vladimir Abadjiev, Controller
(702) 526-3146

Addresses

2345 East Bonanza Road
Las Vegas, NV 89101

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailALTO PHARMACY600 PILOT RD STE A
LAS VEGASNV89119-901111/29/202111/30/2021 07/01/202307/01/2023
Contract DetailALTO PHARMACY, LLCDBA ALTO PHARMACY 1400 TENNESSEE ST UNIT 2
SAN FRANCISCOCA94107-342111/29/202111/30/2021 07/01/202307/01/2023
Contract DetailAVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282107/08/202208/15/2022 07/01/202307/01/2023
Contract DetailAVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080807/08/202208/15/2022 07/01/202307/01/2023
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237401/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/17/202212/14/2022 07/01/202307/01/2023
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/17/202212/14/2022 07/01/202307/01/2023
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/04/202204/01/2022 07/01/202307/01/2023
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/16/202304/01/2023 07/01/202307/01/2023
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09965 9430 DEL WEBB BLVD
LAS VEGASNV8913401/04/202204/01/2022 07/01/202307/01/2023
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09967 1950 VILLAGE CENTER CIR
LAS VEGASNV8913401/04/202204/01/2022 07/01/202307/01/2023
Contract DetailLONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D
LEXINGTONSC29072-245307/08/202208/15/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01507 2935 S. HOLLYWOOD BLVD
LAS VEGASNV8912201/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08780 10400 WEST CHARLESTON BLVD
LAS VEGASNV8913501/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08782 7007 WEST ANN ROAD
LAS VEGASNV8913001/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08784 8116 S LAS VEGAS BLVD
LAS VEGASNV8912301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08788 1812 E. CHARLESTON BLVD.
LAS VEGASNV8910401/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08790 3550 W. SAHARA AVE
LAS VEGASNV8910201/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08791 8580 W. CHARLESTON BLVD
LAS VEGASNV8911701/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08794 1600 N. BUFFALO DRIVE
LAS VEGASNV8912801/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08798 5985 W. TROPICANA RD
LAS VEGASNV8910301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08800 6705 E. LAKE MEAD BLVD
LAS VEGASNV8915601/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08803 2855 S NELLIS BLVD
LAS VEGASNV8912101/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08805 3810 E. SUNSET RD
LAS VEGASNV8912001/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08807 5681 BOULDER HIGHWAY
LAS VEGASNV8912201/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08809 4014 S. RAINBOW BLVD.
LAS VEGASNV8910301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08811 2100 WEST CHARLESTON BLVD.
LAS VEGASNV8910201/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08814 2525 S BUFFALO DR
LAS VEGASNV8911701/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08819 4800 W. CHARLESTON BLVD
LAS VEGASNV8914601/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08821 8320 W CHEYENNE AVE
LAS VEGASNV8912901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08824 4411 E. BONANZA RD
LAS VEGASNV8911001/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08827 6100 SPRING MOUNTAIN ROAD
LAS VEGASNV8914601/04/202204/01/2022 07/01/202307/01/2023
Contract DetailNEVADA CVS PHARMACY, L.L.C.CVS/PHARMACY # 10861 8491 FARM RD.
LAS VEGASNV8913101/04/202204/01/2022 07/01/202307/01/2023
Contract DetailPHARMA BUDDIES CORPROSEMONT SPECIALTY PHARMACY 1727 ORLANDO CENTRAL PKWY
ORLANDOFL3280908/10/202208/15/2022 07/01/202307/01/2023
Contract DetailPHARMA BUDDIES CORPROSEMONT SPECIALTY PHARMACY 1727 ORLANDO CENTRAL PKWY
ORLANDOFL3280908/10/202208/15/2022 07/01/202307/01/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/04/202204/01/2022 07/01/202307/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 445 CASTRO STREET
SAN FRANCISCOCA9411401/04/202204/01/2022 07/01/202307/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWALGREEN ARIZONA DRUG COWALGREENS SPECIALTY PHARMACY #21213 5149 W THUNDERBIRD RD.
GLENDALEAZ8530610/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN ARIZONA DRUG CO.WALGREENS CENTRAL FILL #21372 120 N 83RD AVE
STE 200
TOLLESONAZ8535310/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03841 6101 W LAKE MEAD
LAS VEGASNV8910810/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03842 2389 E WINDMILL LANE
LAS VEGASNV8912310/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03843 2995 E FLAMINGO
LAS VEGASNV8912110/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03844 5011 E. SAHARA AVE.
LAS VEGASNV8914210/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03845 2280 N LAS VEGAS BLVD
NORTH LAS VEGASNV8903010/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03871 1701 N GREEN VALLEY PKWY STE 14
HENDERSONNV8907410/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03873 6865 W TROPICANA AVE
LAS VEGASNV8910310/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03922 7599 W LAKE MEAD BLVD
LAS VEGASNV8912810/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04086 4470 E. BONANZA ROAD
LAS VEGASNV8911010/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04106 1101 S LAS VEGAS BLVD
LAS VEGASNV8910410/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04137 9415 W. DESERT INN
LAS VEGASNV8911710/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04197 8500 W. CHEYENNE AVE.
LAS VEGASNV8912910/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04242 9420 W. LAKE MEAD
LAS VEGASNV8913410/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04433 4895 BOULDER HWY STE 100
LAS VEGASNV8912110/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05154 4905 W TROPICANA AVE
LAS VEGASNV8910310/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05814 1445 W CRAIG RD STE 100
NORTH LAS VEGASNV8903210/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15312 901 S RANCHO DR STE 20
LAS VEGASNV8910610/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05369 1500 S BOULDER
HENDERSONNV8901510/16/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 06545 11001 S EASTERN AVE
HENDERSONNV8905210/16/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11668 6390 BOULDER HWY.
LAS VEGASNV8912210/16/202212/14/2022 07/01/202307/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/16/202304/01/2023 07/01/202307/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/16/202304/01/2023 07/01/202307/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/16/202304/01/2023 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 02928 1825 E. WARM SPRINGS RD.
LAS VEGASNV8911901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 02929 7190 W. CRAIG RD.
LAS VEGASNV8912901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 02930 4595 E. FLAMINGO RD.
LAS VEGASNV8912101/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 02955 3290 S. FORT APACHE RD.
LAS VEGASNV8911701/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 02990 6391 W. LAKE MEAD BLVD.
LAS VEGASNV8910801/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 03210 3758 LAS VEGAS BLVD., SOUTH
LAS VEGASNV8910901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 04784 3270 S. BUFFALO DR.
LAS VEGASNV8911701/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 04786 2735 S. MARYLAND PARKWAY
LAS VEGASNV8910901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 05043 9695 S. MARYLAND PKWY.
LAS VEGASNV8912301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 05068 9405 W. RUSSELL RD.
LAS VEGASNV8914801/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 05113 7295 S. RAINBOW BLVD.
LAS VEGASNV8911801/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 05144 1425 W. LAKE MEAD BLVD.
LAS VEGASNV8910601/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 05792 2425 E. DESERT INN RD.
LAS VEGASNV8912101/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 05942 7285 S. DURANGO DR.
LAS VEGASNV8911301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 06867 4490 PARADISE RD.
LAS VEGASNV8916901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS/PHARMACY # 10348 3645 LAS VEGAS BLVD., SOUTH
LAS VEGASNV8910901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 16079 4001 S MARYLAND PKWY
LAS VEGASNV8911901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 16273 3210 N TENAYA WAY
LAS VEGASNV8912901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 16291 3550 S RAINBOW BLVD
LAS VEGASNV8910301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 16531 9725 S EASTERN AVE
LAS VEGASNV8918301/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 16562 8750 W CHARLESTON BLVD
LAS VEGASNV8911701/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 16794 6480 SKY POINTE DR
LAS VEGASNV8913101/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 16854 4155 S GRAND CANYON DR
LAS VEGASNV8914701/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 17244 4100 BLUE DIAMOND RD
LAS VEGASNV8913901/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 17579 6371 N DECATUR BLVD
LAS VEGASNV8913001/04/202204/01/2022 07/01/202307/01/2023
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 02989 4755 WEST ANN RD.
NORTH LAS VEGASNV8903110/13/202212/14/2022 07/01/202307/01/2023
Contract DetailWASHINGTON LAMB CVS, L.L.C.DBA: CVS/PHARMACY # 03172 4391 E. WASHINGTON AVE.
LAS VEGASNV8911001/04/202204/01/2022 07/01/202307/01/2023
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdateProfile Change RequestDybik, Jami Director Sagebrush Health 8438145177Dybik, Jami Vice President Sagebrush Health Services 84381451775/8/2024 8:41 AM
DetailsStateUpdate To Be TerminatedTerminated7/1/2023 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateRecertification 5/22/2023 12:00:00 AM5/29/2023 10:27 AM
DetailsStateUpdateRecertificationActiveTo Be Terminated5/29/2023 10:27 AM
TerminationsTermination CommentsUpdateRecertification This clinic is now under new ownership5/29/2023 10:27 AM
TerminationsTermination DateUpdateRecertification 7/1/2023 12:00:00 AM5/29/2023 10:27 AM
TerminationsTermination Effective DateUpdateRecertification 5/22/2023 12:00:00 AM5/29/2023 10:27 AM
TerminationsTermination ReasonUpdateRecertification Other5/29/2023 10:27 AM
ContactsAuthorizing OfficialUpdateChange RequestDybik, Jami Director Sagebrush Health Services 8438145177Dybik, Jami Director Sagebrush Health 84381451773/31/2023 1:25 PM
ContactsPrimary ContactUpdateChange RequestAbadjiev, Vladimir Operations Manager Sagebrush Health Services 7025263146Abadjiev, Vladimir Controller Sagebrush Health 70252631463/31/2023 1:25 PM
ContactsPrimary ContactUpdateGroup Change RequestDybik, Jami Director Sagebrush Health Services 8438145177Abadjiev, Vladimir Operations Manager Sagebrush Health Services 702526314610/19/2022 12:48 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestAbadjiev, Vladimir Operations Manager Sagebrush Health Services 7025263146Dybik, Jami Director Sagebrush Health Services 843814517710/19/2022 12:48 PM
ContactsPrimary ContactUpdateRecertificationMcCalister, Page VP of Operations Sagebrush Health Services 7028601386Dybik, Jami Director Sagebrush Health Services 84381451776/6/2022 11:19 AM
DetailsLast Recertification DateUpdateRecertification 6/6/2022 11:19:39 AM6/6/2022 11:19 AM
DetailsStateUpdate ApprovedActive1/1/2022 12:01 AM
ContactsSigned ByInsertNew Registration Abadjiev, Vladimir Operations Manager Sagebrush Health Services 702526314611/3/2021 1:49 PM
Details340B IDUpdateNew Registration STD89101211/3/2021 1:49 PM
DatesParticipating Approval DateUpdateNew Registration 11/3/2021 1:49:57 PM11/3/2021 1:49 PM
DetailsStateUpdateNew RegistrationPendingApproved11/3/2021 1:49 PM
DatesSigned By DateUpdateNew Registration 10/14/2021 5:21:18 PM11/3/2021 1:49 PM
DatesStart DateUpdateNew Registration 1/1/2022 12:00:00 AM11/3/2021 1:49 PM
AddressesMain AddressInsertNew Registration  2345 East Bonanza Road Las Vegas, NV 8910110/14/2021 5:21 PM
DetailsNature of Support: In Kind Support DescriptionInsertNew Registration The in-kind donation we received from the Nevada Department of Health and Human Services is condoms.10/14/2021 5:21 PM
DetailsNature Of SupportInsertNew Registration In-Kind products or services (see note below; must have been purchased with section 318 funds)10/14/2021 5:21 PM
DetailsNature of Support: Support Received From DateInsertNew Registration 1/1/2019 12:00:00 AM10/14/2021 5:21 PM
DetailsNature of Support: Support Received To DateInsertNew Registration 12/31/2023 12:00:00 AM10/14/2021 5:21 PM
ContactsAuthorizing OfficialInsertNew Registration Abadjiev, Vladimir Operations Manager Sagebrush Health Services 702526314610/14/2021 5:21 PM
ContactsPrimary ContactInsertNew Registration McCalister, Page VP of Operations Sagebrush Health Services 702860138610/14/2021 5:21 PM
DetailsAssistance Received From DateInsertNew Registration  10/14/2021 5:21 PM
DetailsAssistance Received To DateInsertNew Registration  10/14/2021 5:21 PM
DetailsLast Recertification DateInsertNew Registration  10/14/2021 5:21 PM
DetailsGrant NumberInsertNew Registration 6 NH25PS005179-03-0510/14/2021 5:21 PM
Details340B IDInsertNew Registration  10/14/2021 5:21 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/14/2021 5:21 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/14/2021 5:21 PM
DetailsMedicare Provider NumberInsertNew Registration  10/14/2021 5:21 PM
DetailsEntity NameInsertNew Registration Sagebrush Health Services10/14/2021 5:21 PM
DetailsNOFO NumberInsertNew Registration PS19-190110/14/2021 5:21 PM
DetailsProgram CodeInsertNew Registration STD10/14/2021 5:21 PM
DetailsEntity SubnameInsertNew Registration Bonanza Clinic10/14/2021 5:21 PM
DatesParticipating Approval DateInsertNew Registration  10/14/2021 5:21 PM
DetailsStateInsertNew Registration Pending10/14/2021 5:21 PM
DatesRegistration DateInsertNew Registration 10/14/2021 5:21:15 PM10/14/2021 5:21 PM
DatesSigned By DateInsertNew Registration  10/14/2021 5:21 PM
DatesStart DateInsertNew Registration  10/14/2021 5:21 PM
TerminationsTermination CommentsInsertNew Registration  10/14/2021 5:21 PM
TerminationsTermination DateInsertNew Registration  10/14/2021 5:21 PM
TerminationsTermination Effective DateInsertNew Registration  10/14/2021 5:21 PM
TerminationsTermination ReasonInsertNew Registration  10/14/2021 5:21 PM