340B Drug Pricing Program Database
OPTUM PHARMACY 801, INC.
STD890482 Sagebrush Health Services - information as of 5/29/2025 2:11:08 AM
Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Pahrump Clinic - KSOSN
Type
Sexually Transmitted Diseases
340B ID
STD890482
Entity Address
330 South Lola Lane
Suite #200
Pahrump, NV 89048
Grant Number
6 NH25PS005179-05-02
Participating Start Date
5/1/2023
Last Recertification Date
6/4/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 801, INC.
Pharmacy Address
24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
5/1/2023
Contract Begin Date
6/14/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/16/2023
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