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LONGS DRUGS OF LEXINGTON
STD331391 PREVENTION 305
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Covered Entity Details
Entity Name
PREVENTION 305
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD331391
Entity Address
407 Lincoln Road, Suite 6D
MIAMI BEACH, FL 33139
Grant Number
NH25PS005131
Participating Start Date
5/8/2020
Last Recertification Date
5/9/2025
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
5/8/2020
Contract Begin Date
5/8/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Whiteside, Chief Executive Officer
(866) 773-7305 Ext: 100
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/14/2020
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