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SENDERRA RX PARTNERS, LLC
STD891045 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
ProCare Medical Group Nellis Clinic- Desert Mountain
Type
Sexually Transmitted Diseases
340B ID
STD891045
Entity Address
2208 S Nellis Blvd
Suite 5
Las Vegas, NV 89104
Grant Number
6 NH25PS005179-05-03
Participating Start Date
10/1/2023
Last Recertification Date
6/11/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
SENDERRA RX PARTNERS, LLC
Pharmacy Address
991 AVIATION PKWY STE 200
MORRISVILLE, NC 27560-9101
Pharmacy Comments
Contract Details
Approval Date
8/21/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/4/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Senderra Rx Specialty Pharmacy
Galina Davis, Manager Managed Care Strategies
(214) 446-9404
Signed By Date
7/26/2023
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