Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
STD89129 Sagebrush Health Services

Covered Entity Details

Entity Name

Sagebrush Health Services

Subdivision Name

Pointe Plaza Clinic - KSOSN

Type

Sexually Transmitted Diseases

340B ID

STD89129

Entity Address

7326 W. Cheyenne Ave.
Suite #110
Las Vegas, NV 89129

Grant Number

6 NH25PS005179-05-03

Participating Start Date

5/1/2023

Last Recertification Date

6/4/2024

Entity Termination Date

1/1/2025

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

5/1/2023

Contract Begin Date

6/7/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jami Dybik, Vice President
(843) 814-5177

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/12/2023

340B Drug Pricing Program Database