Contract Pharmacy Details

CAREMARK, L.L.C.
STD891286 Sagebrush Health Services

Covered Entity Details

Entity Name

Sagebrush Health Services

Subdivision Name

Dr. Ann Wierman, MD

Type

Sexually Transmitted Diseases

340B ID

STD891286

Entity Address

3150 N. Tenaya Way
Ste 200
Las Vegas, NV 89128

Grant Number

6 NH25PS005179-05-03

Participating Start Date

5/1/2023

Last Recertification Date

6/1/2024

Entity Termination Date

1/14/2025

Pharmacy Details

Pharmacy Name

CAREMARK, L.L.C.

Pharmacy Address

DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119

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

1/14/2025
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

4/24/2023

340B Drug Pricing Program Database