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AMAZON PHARMACY #001
STD06489 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Southington Clinic - CT
Type
Sexually Transmitted Diseases
340B ID
STD06489
Entity Address
1131 West St. Building #1
Southington, CT 06489
Grant Number
6 NU62PS924521-04-02
Participating Start Date
12/28/2022
Last Recertification Date
6/4/2024
Pharmacy Details
Pharmacy Name
AMAZON PHARMACY #001
Pharmacy Address
4500 S PLEASANT VALLEY RD STE 201
AUSTIN, TX 78744-2911
Pharmacy Comments
Contract Details
Approval Date
10/27/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
amazon Pharmacy
Bridget O'Connell, Managing Officer
(737) 443-4728 Ext: 4434728
Signed By Date
10/27/2024
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