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WALGREEN CO.
STD89169 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Eastern Ave Clinic
Type
Sexually Transmitted Diseases
340B ID
STD89169
Entity Address
3115 South Eastern Avenue
Las Vegas, NV 89169
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 CO.
Pharmacy Address
DBA: WALGREENS # 04137
9415 W. DESERT INN
LAS VEGAS, NV 89117
Pharmacy Comments
Contract Details
Approval Date
10/16/2022
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
10/16/2022
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