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THE STOP & SHOP SUPERMARKT CO
STD068107 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Danbury Rd Clinic
Type
Sexually Transmitted Diseases
340B ID
STD068107
Entity Address
105 Newtown Rd
Ste B
Danbury, CT 06810
Grant Number
6 NU62PS924521-04-02
Participating Start Date
4/1/2023
Last Recertification Date
5/31/2024
Entity Termination Date
1/14/2025
Pharmacy Details
Pharmacy Name
THE STOP & SHOP SUPERMARKT CO
Pharmacy Address
DBA STOP & SHOP PHARMACY#644
44 LAKE AVE EXTENSION
DANBURY, CT 06811-5244
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
1/14/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Stop and Shop
David Dunn, Pharmacy Operations Manager
(774) 644-1263
Signed By Date
5/5/2023
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