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LONGS DRUGS OF LEXINGTON
STD462012 DAMIEN CENTER INC, THE
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Covered Entity Details
Entity Name
DAMIEN CENTER INC, THE
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD462012
Entity Address
26 N Arsenal Avenue
Indianapolis, IN 46201
Grant Number
NU62PS924804
Participating Start Date
10/1/2019
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
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alan Witchey, President and CEO
(317) 632-0123 Ext: 266
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/14/2020
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