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SCRIPTCO PHARMACY
STD89123 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Eastern Rheumatology
Type
Sexually Transmitted Diseases
340B ID
STD89123
Entity Address
8440 South Eastern Avenue
A
Las Vegas, NV 89123
Grant Number
6 NH25PS005179-05-03
Participating Start Date
1/1/2022
Last Recertification Date
6/11/2024
Entity Termination Date
1/14/2025
Pharmacy Details
Pharmacy Name
SCRIPTCO PHARMACY
Pharmacy Address
6916 WOODWAY DR.
WOODWAY, TX 76712
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
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
Scriptco Pharmacy
Mark McCormick, CEO
(254) 300-7633
Signed By Date
7/15/2024
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