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LONGS DRUGS OF LEXINGTON
RWI97209A Cascade AIDS Project
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Covered Entity Details
Entity Name
Cascade AIDS Project
Subdivision Name
Type
Ryan White Part A
340B ID
RWI97209A
Entity Address
2236 SE Belmont Street
Portland, OR 97214
Grant Number
H89HA00040
Participating Start Date
4/1/2017
Last Recertification Date
1/29/2020
Entity Termination Date
7/1/2020
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
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tyler A. TerMeer, Executive Director
(503) 278-3810
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
10/14/2019
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