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WALGREENS SPECIALTY PHARMACY, LLC
STD06042 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Rheumatology Specialists of Connecticut
Type
Sexually Transmitted Diseases
340B ID
STD06042
Entity Address
543 N Main St
Suite A
Manchester, CT 06042
Grant Number
6 NU62PS924521-04-02
Participating Start Date
5/9/2023
Last Recertification Date
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
5/9/2023
Contract Begin Date
6/8/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
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
4/25/2023
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