Contract Pharmacy Details

INFUCARE RX
STD06489 Sagebrush Health Services

Covered Entity Details

Entity Name

Sagebrush Health Services

Subdivision Name

Southington Clinic - CT

Type

Sexually Transmitted Diseases

340B ID

STD06489

Entity Address

1131 West St. Building #1
Southington, CT 06489

Grant Number

6 NU62PS924521-04-02

Participating Start Date

12/28/2022

Last Recertification Date

6/4/2024

Pharmacy Details

Pharmacy Name

INFUCARE RX

Pharmacy Address

8101 RIDGEPOINT DR STE 100
IRVING, TX 75063-3165

Pharmacy Comments

Contract Details

Approval Date

5/5/2023

Contract Begin Date

6/8/2023

Carve-In Effective Date

Contract Comments

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