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LONGS DRUGS OF LEXINGTON
CHC28362-00 ODYSSEY HOUSE LOUISIANA, INC.
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Covered Entity Details
Entity Name
ODYSSEY HOUSE LOUISIANA, INC.
Subdivision Name
Odyssey House Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC28362-00
Entity Address
2700 S BROAD AVENUE
NEW ORLEANS, LA 70125
Grant Number
H80CS28362
Participating Start Date
1/1/2019
Last Recertification Date
2/23/2025
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
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/16/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Edward C. Carlson, CEO
(504) 494-9628 Ext: 5044949628
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/12/2019
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