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ALTO PHARMACY
STD891012 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Bonanza Clinic
Type
Sexually Transmitted Diseases
340B ID
STD891012
Entity Address
2345 East Bonanza Road
Las Vegas, NV 89101
Grant Number
6 NH25PS005179-03-05
Participating Start Date
1/1/2022
Last Recertification Date
6/6/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
ALTO PHARMACY
Pharmacy Address
600 PILOT RD STE A
LAS VEGAS, NV 89119-9011
Pharmacy Comments
Contract Details
Approval Date
11/29/2021
Contract Begin Date
11/30/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Vladimir Abadjiev, Operations Manager
(702) 526-3146
Contract Pharmacy Representative
Alto Pharmacy
Jaime LaFontaine, Director of Enterprise
(916) 539-4587
Signed By Date
11/29/2021
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