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TRINITY PHARMACY LLC
STD891182 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Southwest Clinic - NKDHC
Type
Sexually Transmitted Diseases
340B ID
STD891182
Entity Address
5815 S Rainbow Blvd.
110
Las Vegas, NV 89118
Grant Number
6 NH25PS005179-05-02
Participating Start Date
11/29/2022
Last Recertification Date
5/31/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
TRINITY PHARMACY LLC
Pharmacy Address
TRINITY PHARMACY
2797 S. MARYLAND PKWY., STE 28
LAS VEGAS, NV 89109-8910
Pharmacy Comments
Contract Details
Approval Date
10/21/2023
Contract Begin Date
1/1/2024
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
Trinity Pharmacy LLC
Sanjay Veerkar, CEO
(702) 776-8210
Signed By Date
10/21/2023
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