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LONGS DRUGS OF LEXINGTON
STD303038 Empowerment Resource Center
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Covered Entity Details
Entity Name
Empowerment Resource Center
Subdivision Name
Mobile2
Type
Sexually Transmitted Diseases
340B ID
STD303038
Entity Address
230 Peachtree Street NW
Suite 1800
Atlanta, GA 30303-1514
Grant Number
5NH25PS004329-04-00
Participating Start Date
10/1/2019
Last Recertification Date
5/6/2025
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
9/4/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jacqueline Brown, Chief Executive Officer
(404) 526-1145
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
7/12/2019
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