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LONGS DRUGS OF LEXINGTON
STD28202 RAO Community Health
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Covered Entity Details
Entity Name
RAO Community Health
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD28202
Entity Address
321 W 11 St.
Charlotte, NC 28202-0092
Grant Number
NH25PS005152
Participating Start Date
10/1/2019
Last Recertification Date
5/7/2025
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
7/31/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bernard Davis, Executive Director
(704) 237-8793
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/1/2019
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