Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
STD891691 Sagebrush Health Services

Covered Entity Details

Entity Name

Sagebrush Health Services

Subdivision Name

Central Clinic - NKDHC

Type

Sexually Transmitted Diseases

340B ID

STD891691

Entity Address

2545 S. Bruce St
Ste.200
Las Vegas, NV 89169

Grant Number

6 NH25PS005179-05-02

Participating Start Date

11/29/2022

Last Recertification Date

5/21/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203

Pharmacy Comments

Contract Details

Approval Date

11/29/2022

Contract Begin Date

12/15/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
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