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LONGS DRUGS OF LEXINGTON
FQHCLA405 Cascade Aids Project
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Covered Entity Details
Entity Name
Cascade Aids Project
Subdivision Name
Prism Health
Type
Health Center Program Look-Alike
340B ID
FQHCLA405
Entity Address
2236 SE Belmont St
Portland, OR 97214-2817
Grant Number
LALCS33965
Participating Start Date
4/16/2020
Last Recertification Date
2/24/2025
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
4/2/2020
Contract Begin Date
4/21/2020
Carve-In Effective Date
Contract Comments
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
4/1/2020
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