Contract Pharmacy Details

WALGREEN ARIZONA DRUG CO
STD891062 Sagebrush Health Services

Covered Entity Details

Entity Name

Sagebrush Health Services

Subdivision Name

Northeast Clinic - NKDHC

Type

Sexually Transmitted Diseases

340B ID

STD891062

Entity Address

1581 Mount Mariah Dr
150
Las Vegas, NV 89106

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 SPECIALTY PHARMACY #21213
5149 W THUNDERBIRD RD.
GLENDALE, AZ 85306

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

340B Drug Pricing Program Database