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LONGS DRUGS OF LEXINGTON
RW424818A Ware County Board of Health
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Covered Entity Details
Entity Name
Ware County Board of Health
Subdivision Name
Coffee Wellness Center
Type
Ryan White Part D
340B ID
RW424818A
Entity Address
310 West Bryan St.
Douglas, GA 31533
Grant Number
H12HA24818
Participating Start Date
4/1/2020
Last Recertification Date
2/10/2025
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
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rosemarie Parks, District Health Director
(912) 285-6002
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/14/2020
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