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LONGS DRUGS OF LEXINGTON
HV0413130E Montgomery AIDS Outreach, Inc
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Covered Entity Details
Entity Name
Montgomery AIDS Outreach, Inc
Subdivision Name
Atmore Clinic
Type
Ryan White Part C
340B ID
HV0413130E
Entity Address
1321 S. Main Street
Atmore, AL 36502
Grant Number
H76HA00099
Participating Start Date
7/1/2019
Last Recertification Date
2/1/2022
Entity Termination Date
4/1/2023
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
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
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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