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WALGREEN ARIZONA DRUG CO.
STD891481 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
CDIN Clinic
Type
Sexually Transmitted Diseases
340B ID
STD891481
Entity Address
9260 W Sunset Rd
306
Las Vegas, NV 89148
Grant Number
6 NH25PS005179-03-05
Participating Start Date
5/1/2023
Last Recertification Date
5/18/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
WALGREENS CENTRAL FILL #21372
120 N 83RD AVE
STE 200
TOLLESON, AZ 85353
Pharmacy Comments
Contract Details
Approval Date
5/1/2023
Contract Begin Date
6/16/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/24/2023
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