Contract Pharmacy Details

CVS CAREMARK
STD89134 Sagebrush Health Services

Covered Entity Details

Entity Name

Sagebrush Health Services

Subdivision Name

Sun City Clinic

Type

Sexually Transmitted Diseases

340B ID

STD89134

Entity Address

9300 Sun City Boulevard
101
Las Vegas, NV 89134

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

CVS CAREMARK

Pharmacy Address

DBA CVS/CAREMARK OR CF# 11506
1 GREAT VALLEY BOULEVARD
WILKES BARRE, PA 18706

Pharmacy Comments

Contract Details

Approval Date

10/17/2022

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

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/17/2022

340B Drug Pricing Program Database