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PROXYCARE
STD89118 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Rainbow Rheumatology
Type
Sexually Transmitted Diseases
340B ID
STD89118
Entity Address
5980 South Rainbow Boulevard
100
Las Vegas, NV 89118
Grant Number
6 NH25PS005179-05-03
Participating Start Date
1/1/2022
Last Recertification Date
6/4/2024
Entity Termination Date
1/14/2025
Pharmacy Details
Pharmacy Name
PROXYCARE
Pharmacy Address
747 SHOTGUN RD
SUNRISE, FL 33326
Pharmacy Comments
Contract Details
Approval Date
4/30/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2025
Covered Entity Terminated
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
4/30/2024
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