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WARRIORS PHARMACY INC.
STD891132 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Battleborn Health Care
Type
Sexually Transmitted Diseases
340B ID
STD891132
Entity Address
8379 W Sunset Rd
Suite 210
Las Vegas, NV 89113
Grant Number
6 NH25PS005179-05-03
Participating Start Date
10/1/2023
Last Recertification Date
6/11/2024
Pharmacy Details
Pharmacy Name
WARRIORS PHARMACY INC.
Pharmacy Address
5265 ANTHONY WAYNE DR.
DETROIT, MI 48202
Pharmacy Comments
Contract Details
Approval Date
10/29/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/11/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
United Woundcare Institute
Ali Karim, General Manager
(312) 818-9193
Signed By Date
10/29/2023
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