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BUDDY'S PHARMACY LLC
STD06489 Sagebrush Health Services
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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
BUDDY'S PHARMACY LLC
Pharmacy Address
BUDDY'S PHARMACY
3035 S MARYLAND PKWY STE 120
LAS VEGAS, NV 89109-2202
Pharmacy Comments
Contract Details
Approval Date
5/5/2023
Contract Begin Date
5/25/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
PharmFood Group
Harry Patel, Operations Manager
(973) 362-6086
Signed By Date
5/5/2023
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