Contract Pharmacy Details

BUDDY'S PHARMACY LLC
STD89012 Sagebrush Health Services

Covered Entity Details

Entity Name

Sagebrush Health Services

Subdivision Name

Dr. S. Steven Kim, MD - MDVIP

Type

Sexually Transmitted Diseases

340B ID

STD89012

Entity Address

1720 W Horizon Ridge Pkwy
#140
Henderson, NV 89012

Grant Number

6 NH25PS005179-05-02

Participating Start Date

5/1/2023

Last Recertification Date

5/22/2023

Entity Termination Date

4/1/2024

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

4/1/2024
Covered Entity Terminated

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

340B Drug Pricing Program Database