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TRINITY PHARMACY LLC
STD890523 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
NV Family Care Center
Type
Sexually Transmitted Diseases
340B ID
STD890523
Entity Address
861 Coronado Center Dr.
Ste 220
Henderson, NV 89052
Grant Number
6 NH25PS005179-05-02
Participating Start Date
5/1/2023
Last Recertification Date
5/18/2023
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
10/29/2023
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
10/29/2023
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