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WATER LILLY PHARMACY LLC
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
WATER LILLY PHARMACY LLC
Pharmacy Address
3700 WASHINGTON ST STE 206
HOLLYWOOD, FL 33021-8249
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
Water Lilly Pharmacy LLC
Gorjana Apostolovic, Pharmacist
(954) 417-5698
Signed By Date
4/15/2025
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