340B Drug Pricing Program Database
ALBERTSON'S LLC
STD891289 Sagebrush Health Services - information as of 6/22/2025 11:53:33 PM
Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Irfan Tahir MD - Desert Mountain
Type
Sexually Transmitted Diseases
340B ID
STD891289
Entity Address
7170 Smoke Ranch Rd
Suite 110
Las Vegas, NV 89128
Grant Number
6 NH25PS005179-05-03
Participating Start Date
10/1/2023
Last Recertification Date
6/11/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
ALBERTSON'S LLC
Pharmacy Address
SAV-ON PHARMACY #0118
7151 WEST CRAIG ROAD
LAS VEGAS, NV 89129
Pharmacy Comments
Contract Details
Approval Date
10/29/2023
Contract Begin Date
1/1/2024
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
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
10/29/2023
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