340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ALTO PHARMACY
STD89118 Sagebrush Health Services
Print
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
ALTO PHARMACY
Pharmacy Address
5916 BOWCROFT ST
LOS ANGELES, CA 90016
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
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
Alto Pharmacy
Karen Martell, VP, Partnerships
(415) 889-9391
Signed By Date
10/15/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session