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ALTO PHARMACY, LLC
STD89123 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Eastern Rheumatology
Type
Sexually Transmitted Diseases
340B ID
STD89123
Entity Address
8440 South Eastern Avenue
A
Las Vegas, NV 89123
Grant Number
6 NH25PS005179-05-03
Participating Start Date
1/1/2022
Last Recertification Date
6/11/2024
Entity Termination Date
1/14/2025
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
Business decision by covered entity and/or pharmacy
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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