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LONGS DRUGS OF LEXINGTON
CH031456E LA RED HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
LA RED HEALTH CENTER, INC.
Subdivision Name
Western Sussex Gynecology Services
Type
HRSA-Funded Health Center
340B ID
CH031456E
Entity Address
105 North Front Street, Suite B
Seaford, DE 19973-1510
Grant Number
H80CS06651
Participating Start Date
4/1/2016
Last Recertification Date
1/29/2019
Entity Termination Date
4/1/2020
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
4/23/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brian Olson, CEO
(302) 855-1233 Ext: 1116
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/23/2019
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