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BENZER PHARMACY ATHENS LLC
STD891281 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Fire Mesa ID
Type
Sexually Transmitted Diseases
340B ID
STD891281
Entity Address
2435 Fire Mesa Street
#120
Las Vegas, NV 89128
Grant Number
6 NH25PS005179-05-03
Participating Start Date
1/1/2022
Last Recertification Date
6/11/2024
Entity Termination Date
1/14/2025
Pharmacy Details
Pharmacy Name
BENZER PHARMACY ATHENS LLC
Pharmacy Address
DBA THE PHARMACY AT PIGGLY WIGGLY ATHENS
484 NORTH AVE
ATHENS, GA 30601
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
1/14/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Benzer pharmacy athens
Kamlesh Sonani, CEO
(919) 334-8202
Signed By Date
10/21/2023
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