Contract Pharmacy Details

LONGS DRUGS OF LEXINGTON
RWI46208 Brothers United, Inc.

Covered Entity Details

Entity Name

Brothers United, Inc.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI46208

Entity Address

1712 North Meridian St.
Suite 200
Indianapolis, IN 46202

Grant Number

H89HA11463

Participating Start Date

1/1/2017

Last Recertification Date

3/10/2025

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

1/11/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Darrin Keith Johnson, Executive Director
(704) 231-6904

Contract Pharmacy Representative

AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587

Signed By Date

1/11/2019

340B Drug Pricing Program Database