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PROCARE PHARMACY, L.L.C.
STD891182 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Southwest Clinic - NKDHC
Type
Sexually Transmitted Diseases
340B ID
STD891182
Entity Address
5815 S Rainbow Blvd.
110
Las Vegas, NV 89118
Grant Number
6 NH25PS005179-05-02
Participating Start Date
11/29/2022
Last Recertification Date
5/31/2023
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
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