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TRINITY PHARMACY LLC
STD891485 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
ProCare Medical Group Fort Apache Clinic- Desert Mountain
Type
Sexually Transmitted Diseases
340B ID
STD891485
Entity Address
5270 S Fort Apache Rd.
Suite 330
Las Vegas, NV 89148
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
TRINITY PHARMACY LLC
Pharmacy Address
TRINITY PHARMACY
2797 S. MARYLAND PKWY., STE 28
LAS VEGAS, NV 89109-8910
Pharmacy Comments
Contract Details
Approval Date
10/25/2023
Contract Begin Date
1/1/2024
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
Trinity Pharmacy LLC
Sanjay Veerkar, CEO
(702) 776-8210
Signed By Date
10/25/2023
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