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LONGS DRUGS OF LEXINGTON
STD36609 AIDS Alabama South
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Covered Entity Details
Entity Name
AIDS Alabama South
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD36609
Entity Address
4321 Downtowner Loop North
Mobile, AL 36609
Grant Number
5 NH25PS005129-03-00
Participating Start Date
7/1/2018
Last Recertification Date
5/6/2025
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
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lanita Khalil, Executive Director
(251) 545-4665
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/13/2020
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