Covered Entity Details

STD891441 Sagebrush Health Services (Terminated) - information as of 5/13/2025 10:57:23 PM

Main Details

Name

Sagebrush Health Services

Subdivision Name

New Eyes - Summerlin Clinic

Type

Sexually Transmitted Diseases

340B ID

STD891441

Grant Number

6 NH25PS005179-03-05

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

Direct Funding (dollars received from CDC or an intermediate organization)
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.
Condoms and Marketing Material
1/1/2019 - 12/31/2023

Additional Details

Current Program Status

Terminated

Registration Date

4/12/2023

Participating Start Date

5/1/2023

Participating Approval Date

5/1/2023

Last Recertification Date

5/18/2023

Notice of Funding Opportunity (NOFO) Number

PS19-1901

Termination Date
Termination Reason

10/1/2023
Business decision by the Covered Entity

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

10105 Banburry Cross Dr.
Suite 255
Las Vegas, NV 89144

Billing Address

Sagebrush Health Service
8379 W Sunset Rd
210
Las Vegas, NV 89113

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #0118	7151 WEST CRAIG ROAD	LAS VEGAS	NV	89129	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #662	2885 EAST DESERT INN	LAS VEGAS	NV	89121	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #0093	1008 NEVADA WAY	BOULDER CITY	NV	89005	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #90	7075 WEST ANN ROAD	LAS VEGAS	NV	89130	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #3205	575 COLLEGE DRIVE	HENDERSON	NV	89015	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #4004	4055 SOUTH DURANGO DRIVE	LAS VEGAS	NV	89147	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #3333	1940 VILLAGE CENTER CIRCLE	LAS VEGAS	NV	89134	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #4091	5881 E. CHARLESTON BLVD.	LAS VEGAS	NV	89142	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #61	4850 WEST CRAIG ROAD	LAS VEGAS	NV	89130	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #1059	5500 BOULDER HIGHWAY	LAS VEGAS	NV	89122	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #2	201 SOUTH STEPHANIE STREET	HENDERSON	NV	89012	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #4009	8410 FARM ROAD	LAS VEGAS	NV	89131	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #0276	7350 SOUTH RAINBOW BLVD.	LAS VEGAS	NV	89139	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #3206	190 NORTH BOULDER HIGHWAY	HENDERSON	NV	89015	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #0460	11720 W. CHARLESTON BLVD.	LAS VEGAS	NV	89135	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #0046	1001 S. RAINBOW BLVD	LAS VEGAS	NV	89145	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #3021	10140 WEST FLAMINGO ROAD	LAS VEGAS	NV	89147	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #3016	10250 WEST CHARLESTON BLVD.	LAS VEGAS	NV	89135	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #0332	4800 BLUE DIAMOND ROAD	LAS VEGAS	NV	89139	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #4005	3010 WEST ANN ROAD	NORTH LAS VEGAS	NV	89031	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSONS LLC	SAV-ON PHARMACY #3489	6730 N HUALAPAI WAY	LAS VEGAS	NV	89149	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSONS LLC	SAV-ON PHARMACY #3207	2910 BICENTENNIAL PARKWAY	HENDERSON	NV	89044	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSONS LLC	ALBERTSONS PHARMACY #155	2582 IDAHO ST	ELKO	NV	89801	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	ALBERTSONS LLC	SAV-ON PHARMACY #2804	7975 BLUE DIAMOND RD	LAS VEGAS	NV	89178	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	05/05/2023	06/13/2023	10/01/2023	10/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/17/2023	10/01/2023	10/01/2023	10/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	05/05/2023	06/13/2023	10/01/2023	10/01/2023
Contract Detail	BUDDY'S PHARMACY LLC	BUDDY'S PHARMACY	3035 S MARYLAND PKWY STE 120	LAS VEGAS	NV	89109-2202	05/05/2023	05/25/2023	10/01/2023	10/01/2023
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	05/01/2023	06/07/2023	10/01/2023	10/01/2023
Contract Detail	GENOA HEALTHCARE LLC	701 SHADOW LN STE 110		LAS VEGAS	NV	89106	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 401, LLC	4610 NORTHGATE BLVD.	STE. 130	SACRAMENTO	CA	95834-1154	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	05/01/2023	06/14/2023	10/01/2023	10/01/2023
Contract Detail	PHARMA BUDDIES CORP	ROSEMONT SPECIALTY PHARMACY	1727 ORLANDO CENTRAL PKWY	ORLANDO	FL	32809	05/01/2023	05/09/2023	10/01/2023	10/01/2023
Contract Detail	PHARMA BUDDIES CORP	ROSEMONT SPECIALTY PHARMACY	1727 ORLANDO CENTRAL PKWY	ORLANDO	FL	32809	05/01/2023	05/09/2023	10/01/2023	10/01/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1537	212 ELKS POINT RD PO BOX 11111	ZEPHYR COVE	NV	89448	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0188	1031 STEAMBOAT PKWY	RENO	NV	89521-6238	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #2656	2858 VISTA BLVD	SPARKS	NV	89434	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #2255	HIGHWAY 95 & ARMORY	HAWTHORNE	NV	89415	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1210	5150 MAE ANNE AVE #300	RENO	NV	89523	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1517	890 W WILLIAMS	FALLON	NV	89406	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	THE VONS COMPANIES INC	VONS PHARMACY #2511	2667 WINDMILL PKWY	HENDERSON	NV	89074	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	THE VONS COMPANIES INC	VONS PHARMACY #2390	475 EAST WINDMILL LANE	LAS VEGAS	NV	89123	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	THE VONS COMPANIES INC	VONS PHARMACY #1963	1155 EAST TWAIN AVENUE	LAS VEGAS	NV	89169	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	THE VONS COMPANIES INC	VONS PHARMACY #2615	45 EAST HORIZON RIDGE PARKWAY	HENDERSON	NV	89002	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	THE VONS COMPANIES INC	VONS PHARMACY #2613	6450 SKY POINTE DRIVE	LAS VEGAS	NV	89131	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	THE VONS COMPANIES INC	VONS PHARMACY #1970	8540 WEST DESERT INN ROAD	LAS VEGAS	NV	89117-9155	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	THE VONS COMPANIES INC	VONS PHARMACY #1795	2511 ANTHEM VILLAGE DRIVE	HENDERSON	NV	89052	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	THE VONS COMPANIES INC	VONS PHARMACY #2614	7405 SOUTH DURANGO DR	LAS VEGAS	NV	89113	05/01/2023	06/15/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1559	201 NORTH NELLIS BLVD		LAS VEGAS (NE)	NV	89110	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1560	6005 S. EASTERN AVE		LAS VEGAS	NV	89119	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1584	3615 SOUTH RAINBOW ROAD		LAS VEGAS	NV	89103	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1838	3041 NORTH RAINBOW BLVD		LAS VEGAS	NV	89108	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2050	300 EAST LAKE MEAD DRIVE		HENDERSON	NV	89015	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2592	1807 WEST CRAIG ROAD		NORTH LAS VEGAS	NV	89032	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-3350	5198 BOULDER HIGHWAY		LAS VEGAS	NV	89122	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-3351	6464 NORTH DECATUR BLVD		NORTH LAS VEGAS	NV	89131	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-3355	1400 SOUTH LAMB BLVD.		LAS VEGAS	NV	89104	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-3728	3950 WEST LAKE MEAD BLVD		NORTH LAS VEGAS	NV	89032	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-3788	6310 WEST CHARLESTON BLVD.		LAS VEGAS	NV	89146	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-4339	5940 LOSEE RD		NORTH LAS VEGAS	NV	89081	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-4356	7200 ARROYO CROSS PARKWAY		LAS VEGAS	NV	89113	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-4557	3075 EAST TROPICANA		LAS VEGAS	NV	89121	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5070	5200 S FORT APACHE RD		LAS VEGAS(SW2)	NV	89148	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5306	5545 SIMMONS STREET		NORTH LAS VEGAS	NV	89031	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5423	6570 EAST LAKE MEAD BLVD		LAS VEGAS	NV	89156	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	05/01/2023	05/17/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN ARIZONA DRUG CO	WALGREENS SPECIALTY PHARMACY #21213	5149 W THUNDERBIRD RD.	GLENDALE	AZ	85306	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10782	5610 CENTENNIAL CENTER BLVD.	LAS VEGAS	NV	89149	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04242	9420 W. LAKE MEAD	LAS VEGAS	NV	89134	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11899	6485 S. FORT APACHE RD.	LAS VEGAS	NV	89148	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04197	8500 W. CHEYENNE AVE.	LAS VEGAS	NV	89129	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05154	4905 W TROPICANA AVE	LAS VEGAS	NV	89103	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03845	2280 N LAS VEGAS BLVD	NORTH LAS VEGAS	NV	89030	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05015	9305 S. EASTERN AVE.	LAS VEGAS	NV	89123	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05369	1500 S BOULDER	HENDERSON	NV	89015	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04106	1101 S LAS VEGAS BLVD	LAS VEGAS	NV	89104	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03922	7599 W LAKE MEAD BLVD	LAS VEGAS	NV	89128	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05646	770 S HWY 160	PAHRUMP	NV	89048	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06545	11001 S EASTERN AVE	HENDERSON	NV	89052	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03841	6101 W LAKE MEAD	LAS VEGAS	NV	89108	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04433	4895 BOULDER HWY STE 100	LAS VEGAS	NV	89121	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03844	5011 E. SAHARA AVE.	LAS VEGAS	NV	89142	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03873	6865 W TROPICANA AVE	LAS VEGAS	NV	89103	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05814	1445 W CRAIG RD STE 100	NORTH LAS VEGAS	NV	89032	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11668	6390 BOULDER HWY.	LAS VEGAS	NV	89122	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04137	9415 W. DESERT INN	LAS VEGAS	NV	89117	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15312	901 S RANCHO DR STE 20	LAS VEGAS	NV	89106	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03871	1701 N GREEN VALLEY PKWY STE 14	HENDERSON	NV	89074	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03842	2389 E WINDMILL LANE	LAS VEGAS	NV	89123	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03843	2995 E FLAMINGO	LAS VEGAS	NV	89121	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04086	4470 E. BONANZA ROAD	LAS VEGAS	NV	89110	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12646	329 N. SANDHILL BLVD	MESQUITE	NV	89027-4729	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	05/01/2023	06/16/2023	10/01/2023	10/01/2023
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	05/05/2023	05/17/2023	10/01/2023	10/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Dybik, Jami Director Sagebrush Health 8438145177	Dybik, Jami Vice President Sagebrush Health Services 8438145177	5/8/2024 8:41 AM
Contacts	Signed By	Update	Profile Change Request	Dybik, Jami Director Sagebrush Health 8438145177	Dybik, Jami Vice President Sagebrush Health Services 8438145177	5/8/2024 8:41 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/17/2023 12:00:00 AM	7/26/2023 5:49 PM
Details	State	Update	Termination Request	Active	To Be Terminated	7/26/2023 5:49 PM
Terminations	Termination Date	Update	Termination Request		10/1/2023 12:00:00 AM	7/26/2023 5:49 PM
Terminations	Termination Effective Date	Update	Termination Request		7/17/2023 12:00:00 AM	7/26/2023 5:49 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	7/26/2023 5:49 PM
Details	Last Recertification Date	Update	Recertification		5/18/2023 2:42:57 PM	5/18/2023 2:42 PM
Details	State	Update	OPA Edit	Approved	Active	5/1/2023 2:41 PM
Dates	Start Date	Update	OPA Edit	7/1/2023 12:00:00 AM	5/1/2023 12:00:00 AM	5/1/2023 2:41 PM
Contacts	Signed By	Insert	New Registration		Dybik, Jami Director Sagebrush Health 8438145177	5/1/2023 12:44 PM
Details	340B ID	Update	New Registration		STD891441	5/1/2023 12:44 PM
Dates	Participating Approval Date	Update	New Registration		5/1/2023 12:44:38 PM	5/1/2023 12:44 PM
Details	State	Update	New Registration	Pending	Approved	5/1/2023 12:44 PM
Dates	Signed By Date	Update	New Registration		4/12/2023 7:57:27 PM	5/1/2023 12:44 PM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	5/1/2023 12:44 PM
Addresses	Main Address	Insert	New Registration		10105 Banburry Cross Dr. Suite 255 Las Vegas, NV 89144	4/12/2023 7:57 PM
Addresses	Billing Address	Insert	New Registration		Sagebrush Health Service 8379 W Sunset Rd 210 Las Vegas, NV 89113	4/12/2023 7:57 PM
Details	Nature of Support: In Kind Support Description	Insert	New Registration			4/12/2023 7:57 PM
Details	Nature Of Support	Insert	New Registration		Direct Funding (dollars received from CDC or an intermediate organization)	4/12/2023 7:57 PM
Details	Nature of Support: Support Received From Date	Insert	New Registration		1/1/2019 12:00:00 AM	4/12/2023 7:57 PM
Details	Nature of Support: Support Received To Date	Insert	New Registration		12/31/2023 12:00:00 AM	4/12/2023 7:57 PM
Details	Nature of Support: In Kind Support Description	Insert	New Registration		Condoms and Marketing Material	4/12/2023 7:57 PM
Details	Nature Of Support	Insert	New Registration		In-Kind products or services (see note below; must have been purchased with section 318 funds)	4/12/2023 7:57 PM
Details	Nature of Support: Support Received From Date	Insert	New Registration		1/1/2019 12:00:00 AM	4/12/2023 7:57 PM
Details	Nature of Support: Support Received To Date	Insert	New Registration		12/31/2023 12:00:00 AM	4/12/2023 7:57 PM
Contacts	Authorizing Official	Insert	New Registration		Dybik, Jami Director Sagebrush Health 8438145177	4/12/2023 7:57 PM
Contacts	Primary Contact	Insert	New Registration		Abadjiev, Vladimir Controller Sagebrush Health 7025263146	4/12/2023 7:57 PM
Details	Assistance Received From Date	Insert	New Registration			4/12/2023 7:57 PM
Details	Assistance Received To Date	Insert	New Registration			4/12/2023 7:57 PM
Details	Last Recertification Date	Insert	New Registration			4/12/2023 7:57 PM
Details	Grant Number	Insert	New Registration		6 NH25PS005179-03-05	4/12/2023 7:57 PM
Details	340B ID	Insert	New Registration			4/12/2023 7:57 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/12/2023 7:57 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/12/2023 7:57 PM
Details	Medicare Provider Number	Insert	New Registration			4/12/2023 7:57 PM
Details	Entity Name	Insert	New Registration		Sagebrush Health Services	4/12/2023 7:57 PM
Details	NOFO Number	Insert	New Registration		PS19-1901	4/12/2023 7:57 PM
Details	Program Code	Insert	New Registration		STD	4/12/2023 7:57 PM
Details	Entity Subname	Insert	New Registration		New Eyes - Summerlin Clinic	4/12/2023 7:57 PM
Dates	Participating Approval Date	Insert	New Registration			4/12/2023 7:57 PM
Details	State	Insert	New Registration		Pending	4/12/2023 7:57 PM
Dates	Registration Date	Insert	New Registration		4/12/2023 7:57:24 PM	4/12/2023 7:57 PM
Dates	Signed By Date	Insert	New Registration			4/12/2023 7:57 PM
Dates	Start Date	Insert	New Registration			4/12/2023 7:57 PM
Terminations	Termination Comments	Insert	New Registration			4/12/2023 7:57 PM
Terminations	Termination Date	Insert	New Registration			4/12/2023 7:57 PM
Terminations	Termination Effective Date	Insert	New Registration			4/12/2023 7:57 PM
Terminations	Termination Reason	Insert	New Registration			4/12/2023 7:57 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History