Contract Pharmacy Details

WAL-MART CENTRAL FILL 10-2670
STD891281 Sagebrush Health Services

Entity Name

Sagebrush Health Services

Subdivision Name

Fire Mesa ID

Type

Sexually Transmitted Diseases

340B ID

STD891281

Entity Address

2435 Fire Mesa Street
#120
Las Vegas, NV 89128

Grant Number

6 NH25PS005179-05-02

Participating Start Date

1/1/2022

Last Recertification Date

5/29/2023

Pharmacy Name

WAL-MART CENTRAL FILL 10-2670

Pharmacy Address

608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386

Pharmacy Comments

Approval Date

4/24/2023

Contract Begin Date

5/17/2023

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Jami Dybik, Vice President
(843) 814-5177

Signed By Date

4/24/2023

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498