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LONGS DRUGS OF LEXINGTON
STD333054 Latinos Salud, Inc.
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Covered Entity Details
Entity Name
Latinos Salud, Inc.
Subdivision Name
Medical Mobile Unit Broward
Type
Sexually Transmitted Diseases
340B ID
STD333054
Entity Address
1401 NE 26th Street
Wilton Manors, FL 33305-1321
Grant Number
NU62PS924749
Participating Start Date
4/17/2020
Last Recertification Date
5/5/2025
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
4/17/2020
Contract Begin Date
5/21/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen Fallon, PhD, Executive Director
(786) 310-3152
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/10/2020
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