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LONGS DRUGS OF LEXINGTON
STD29302 Piedmont Care, Inc.
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Covered Entity Details
Entity Name
Piedmont Care, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD29302
Entity Address
101 North Pine St., Suite 200
Spartanburg, SC 29302-1604
Grant Number
NU62PS924641
Participating Start Date
10/1/2020
Last Recertification Date
5/7/2025
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
8/20/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tracey L. Jackson, Executive Director
(864) 582-7773 Ext: 8642744178
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/1/2020
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