Contract Pharmacy Details

LONGS DRUGS OF LEXINGTON
RWI11372 Voces Latinas

Covered Entity Details

Entity Name

Voces Latinas

Subdivision Name

Voces Latinas

Type

Ryan White Part A

340B ID

RWI11372

Entity Address

37-63C 83rd Street, Suite 1B
Jackson Heights, NY 11372

Grant Number

H89HA00015

Participating Start Date

7/30/2020

Last Recertification Date

3/1/2021

Entity Termination Date

4/1/2022

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

8/7/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Nathaly Rubio-Torio, Executive Director
(718) 593-4528

Contract Pharmacy Representative

PharmBlue, LLC
William Broderick, Regional Representative
(412) 491-1095

Signed By Date

8/7/2020

340B Drug Pricing Program Database