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HEALTHCARE EVOLUTION, LLC
STD064731 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
North Haven Clinic- Vivo
Type
Sexually Transmitted Diseases
340B ID
STD064731
Entity Address
127 Washington Ave
4th Floor - West Building
North Haven, CT 06473
Grant Number
6 NU62PS924521-04-02
Participating Start Date
5/9/2023
Last Recertification Date
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
HEALTHCARE EVOLUTION, LLC
Pharmacy Address
649 N LEWIS RD STE 230A
ROYERSFORD, PA 19468
Pharmacy Comments
Contract Details
Approval Date
6/23/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Vivo Infusions
Emma Singh, VP of Pharmacy Operations
(610) 495-6800
Signed By Date
6/23/2023
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