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WALGREEN ARIZONA DRUG CO.
STD89052 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Southeast Clinic - NKDHC
Type
Sexually Transmitted Diseases
340B ID
STD89052
Entity Address
861 Coronado Center Dr.
120
Henderson, NV 89052
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
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
WALGREENS CENTRAL FILL #21372
120 N 83RD AVE
STE 200
TOLLESON, AZ 85353
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2022
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