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FAST ACCESS SPECIALTY THERAPEUTICS
STD064892 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Connecticut Home Infusions
Type
Sexually Transmitted Diseases
340B ID
STD064892
Entity Address
1131 West Street
Suite 1A
Southington, CT 06489
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
FAST ACCESS SPECIALTY THERAPEUTICS
Pharmacy Address
DBA INFUCARE RX OF LA
2400 VETERANS MEMORIAL BLVD STE 480
KENNER, LA 70062-8728
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
Infucare
Mark Milburn, 340B Director
(877) 828-3940
Signed By Date
5/5/2023
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