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LONGS DRUGS OF LEXINGTON
STD331402 Latinos Salud, Inc.
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Covered Entity Details
Entity Name
Latinos Salud, Inc.
Subdivision Name
Medical Mobile Unit Miami-Dade
Type
Sexually Transmitted Diseases
340B ID
STD331402
Entity Address
925 Arthur Godfrey Road
Suite 200
Miami Beach, FL 33140
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
5/21/2020
Contract Begin Date
5/29/2020
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
5/21/2020
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