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WELLS PHARMACY
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
WELLS PHARMACY
Pharmacy Address
247 N LITCHFIELD RD
GOODYEAR, AZ 85338-1227
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Trinity Care
Sanjay Veerkar, Program Manager
(702) 776-8210
Signed By Date
7/15/2024
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