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LONGS DRUGS OF LEXINGTON
STD36111 West Alabama AIDS Outreach
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Covered Entity Details
Entity Name
West Alabama AIDS Outreach
Subdivision Name
Five Horizons Health Services
Type
Sexually Transmitted Diseases
340B ID
STD36111
Entity Address
2900 McGehee Road
Montgomery, AL 36111
Grant Number
6NH25PS005129-05-05
Participating Start Date
10/1/2017
Last Recertification Date
5/5/2025
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
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael R. Murphree, Chief Executive Officer
(334) 280-3349 Ext: 1001
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/10/2019
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