340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-3728
STD89012 Sagebrush Health Services
Print
Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Dr. S. Steven Kim, MD - MDVIP
Type
Sexually Transmitted Diseases
340B ID
STD89012
Entity Address
1720 W Horizon Ridge Pkwy
#140
Henderson, NV 89012
Grant Number
6 NH25PS005179-05-02
Participating Start Date
5/1/2023
Last Recertification Date
5/22/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3728
Pharmacy Address
3950 WEST LAKE MEAD BLVD
NORTH LAS VEGAS, NV 89032
Pharmacy Comments
Contract Details
Approval Date
5/1/2023
Contract Begin Date
5/17/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/24/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session