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LONGS DRUGS OF LEXINGTON
STD303039 Aniz, Inc
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Covered Entity Details
Entity Name
Aniz, Inc
Subdivision Name
Aniz, Inc.
Type
Sexually Transmitted Diseases
340B ID
STD303039
Entity Address
236 Forsyth Street SW, Suite 300
Atlanta, GA 30303
Grant Number
NU62PS924526
Participating Start Date
10/25/2019
Last Recertification Date
5/8/2025
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
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Zina Age, President CEO
(404) 502-9982
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/7/2020
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