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BIOPLUS SPECIALTY PHARMACY, INC
STD891282 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Dixit Clinic
Type
Sexually Transmitted Diseases
340B ID
STD891282
Entity Address
2480 Professional Ct.
Suite 150
Las Vegas, NV 89128
Grant Number
6 NH25PS005179-03-05
Participating Start Date
11/29/2022
Last Recertification Date
5/18/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
BIOPLUS SPECIALTY PHARMACY, INC
Pharmacy Address
3200 LAKE EMMA RD UNIT 1000
LAKE MARY, FL 32746
Pharmacy Comments
Contract Details
Approval Date
4/25/2023
Contract Begin Date
6/13/2023
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
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
4/25/2023
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