Contract Pharmacy Details

INFUCARE RX
STD064892 Sagebrush Health Services

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

INFUCARE RX

Pharmacy Address

8101 RIDGEPOINT DR STE 100
IRVING, TX 75063-3165

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