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LONGS DRUGS OF LEXINGTON
STD09921 Reach LA
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Covered Entity Details
Entity Name
Reach LA
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD09921
Entity Address
1400 E. Olympic Blvd
Suite 240
Los Angeles, CA 90021
Grant Number
NH25PS005130
Participating Start Date
4/1/2019
Last Recertification Date
5/22/2025
Pharmacy Details
Pharmacy Name
LONGS DRUGS OF LEXINGTON
Pharmacy Address
D/B/A AVITA PHARMACY 1051
1216 W MAIN ST
STE D
LEXINGTON, SC 29072-2453
Pharmacy Comments
Contract Details
Approval Date
2/13/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Miguel Bujanda, Executive Director
(213) 622-1650 Ext: 101
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/11/2019
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