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WALGREEN EASTERN CO., INC.
STD06489 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Southington Clinic - CT
Type
Sexually Transmitted Diseases
340B ID
STD06489
Entity Address
1131 West St. Building #1
Southington, CT 06489
Grant Number
6 NU62PS924521-04-02
Participating Start Date
12/28/2022
Last Recertification Date
6/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #07485
107 N. MAIN ST.
PORT CHESTER, NY 10573-4210
Pharmacy Comments
Contract Details
Approval Date
10/27/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
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
10/27/2023
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