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LONGS DRUGS OF LEXINGTON
STD927061 AIDS Services Foundation Orange County dba Radiant Health Centers
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Covered Entity Details
Entity Name
AIDS Services Foundation Orange County dba Radiant Health Centers
Subdivision Name
Radiant Health Centers
Type
Sexually Transmitted Diseases
340B ID
STD927061
Entity Address
2708 Westmnister Avenue
Suite 110
Santa Ana, CA 92706
Grant Number
NU65PS004745
Participating Start Date
4/1/2019
Last Recertification Date
5/29/2020
Entity Termination Date
4/1/2021
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
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Guita Sharifi, CFO
(949) 809-5753
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/10/2019
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