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LONGS DRUGS OF LEXINGTON
RWI63115 Williams and Associates, Inc.
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Covered Entity Details
Entity Name
Williams and Associates, Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI63115
Entity Address
3737 North Kingshighway Blvd.
Suite 204-206
St. Louis, MO 63115
Grant Number
H89HA00033
Participating Start Date
7/1/2016
Last Recertification Date
3/1/2025
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
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erise Williams, President/CEO
(314) 385-1935 Ext: 3143851935
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/15/2019
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