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LONGS DRUGS OF LEXINGTON
RWI92614A 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
Type
Ryan White Part A
340B ID
RWI92614A
Entity Address
2010 E. 1st Street
Suite 270
Santa Ana, CA 92705
Grant Number
H89HA00019
Participating Start Date
7/1/2019
Last Recertification Date
1/29/2020
Entity Termination Date
7/1/2020
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
6/3/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
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
4/12/2019
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