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ALTO PHARMACY, LLC
STD891181 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Stonecreek Clinic
Type
Sexually Transmitted Diseases
340B ID
STD891181
Entity Address
5915 South Rainbow Boulevard
100
Las Vegas, NV 89118
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, LLC
Pharmacy Address
DBA ALTO PHARMACY
1400 TENNESSEE ST UNIT 2
SAN FRANCISCO, CA 94107-3421
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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