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LONGS DRUGS OF LEXINGTON
CH10163J Valley Family Health Care, Inc.
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Covered Entity Details
Entity Name
Valley Family Health Care, Inc.
Subdivision Name
Valley Family Health Care - Payette Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH10163J
Entity Address
1501 NE 10th Ave
Payette, ID 83661-5420
Grant Number
H80CS00556
Participating Start Date
7/1/2017
Last Recertification Date
2/12/2025
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
10/24/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Heinze, CEO
(208) 642-7364
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
10/24/2019
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