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WATER LILLY PHARMACY LLC
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
WATER LILLY PHARMACY LLC
Pharmacy Address
3700 WASHINGTON ST STE 206
HOLLYWOOD, FL 33021-8249
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Water Lilly Pharmacy LLC
Gorjana Apostolovic, Pharmacist
(954) 417-5698
Signed By Date
4/15/2025
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