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WALGREEN ARIZONA DRUG CO
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
WALGREEN ARIZONA DRUG CO
Pharmacy Address
WALGREENS SPECIALTY PHARMACY #21213
5149 W THUNDERBIRD RD.
GLENDALE, AZ 85306
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
12/14/2022
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2022
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