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WALGREEN CO.
STD891286 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Dr. Ann Wierman, MD
Type
Sexually Transmitted Diseases
340B ID
STD891286
Entity Address
3150 N. Tenaya Way
Ste 200
Las Vegas, NV 89128
Grant Number
6 NH25PS005179-05-03
Participating Start Date
5/1/2023
Last Recertification Date
6/1/2024
Entity Termination Date
1/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15035
3150 N TENAYA WAY STE 170
LAS VEGAS, NV 89128
Pharmacy Comments
Contract Details
Approval Date
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mithila Urs, Director
(714) 797-8666
Contract Pharmacy Representative
Walgreens
privacy officer privacy oficer, Privacy Officer
(847) 236-6518
Signed By Date
4/15/2025
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