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SPECIALTY CARE RX
STD891281 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Fire Mesa ID
Type
Sexually Transmitted Diseases
340B ID
STD891281
Entity Address
2435 Fire Mesa Street
#120
Las Vegas, NV 89128
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
SPECIALTY CARE RX
Pharmacy Address
801 S RANCHO DR STE D1-A
LAS VEGAS, NV 89106-3854
Pharmacy Comments
Contract Details
Approval Date
10/30/2024
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
PPC LLC
Jeff Griffith, Partner / Cheif Business Development Office
(714) 602-9571
Signed By Date
10/30/2024
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