Contract Pharmacy Details

PROXYCARE
STD891132 Sagebrush Health Services

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

PROXYCARE

Pharmacy Address

747 SHOTGUN RD
SUNRISE, FL 33326

Pharmacy Comments

Contract Details

Approval Date

4/21/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jami Dybik, Vice President
(843) 814-5177

Contract Pharmacy Representative

Proxycare Inc.
Cindy Cruz, President
(954) 791-5400

Signed By Date

4/21/2024