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LONGS DRUGS OF LEXINGTON
CH10163M Valley Family Health Care, Inc.
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Covered Entity Details
Entity Name
Valley Family Health Care, Inc.
Subdivision Name
Treasure Valley Women and Family Medicine Clinic - VFHC
Type
HRSA-Funded Health Center
340B ID
CH10163M
Entity Address
1219 SW 4th Ave STE 2
Ontario, OR 97914
Grant Number
H80CS00556
Participating Start Date
10/1/2019
Last Recertification Date
2/6/2023
Entity Termination Date
1/1/2024
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
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
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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