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WALGREENS SPECIALTY PHARMACY, LLC
STD891012 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Bonanza Clinic
Type
Sexually Transmitted Diseases
340B ID
STD891012
Entity Address
2345 East Bonanza Road
Las Vegas, NV 89101
Grant Number
6 NH25PS005179-03-05
Participating Start Date
1/1/2022
Last Recertification Date
6/6/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15443
10530 JOHN W ELLIOTT DR STE 100
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jami Dybik, Director
(843) 814-5177
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2023
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