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LONGS DRUGS OF LEXINGTON
STD35801 AIDS Action Coalition of Huntsville, Inc
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Covered Entity Details
Entity Name
AIDS Action Coalition of Huntsville, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD35801
Entity Address
600 St. Clair Ave., Bldg 7 Suite 18
Huntsville, AL 35801
Grant Number
1H25PS004326-01
Participating Start Date
1/1/2016
Last Recertification Date
5/14/2019
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
4/15/2019
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
Mary Elizabeth Marr, CEO
(256) 337-8283
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/15/2019
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