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WALGREEN CO.
STD890142 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Forte Family Practice Warm Springs Clinic - Desert Mountain
Type
Sexually Transmitted Diseases
340B ID
STD890142
Entity Address
1535 W Warm Springs Rd
Suite 135
Henderson, NV 89014
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03873
6865 W TROPICANA AVE
LAS VEGAS, NV 89103
Pharmacy Comments
Contract Details
Approval Date
8/18/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/26/2023
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