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WALGREEN ARIZONA DRUG CO.
STD891282 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Dixit Clinic
Type
Sexually Transmitted Diseases
340B ID
STD891282
Entity Address
2480 Professional Ct.
Suite 150
Las Vegas, NV 89128
Grant Number
6 NH25PS005179-03-05
Participating Start Date
11/29/2022
Last Recertification Date
5/18/2023
Entity Termination Date
1/1/2024
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
1/1/2024
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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