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LONGS DRUGS OF LEXINGTON
STD294071 Roper St. Francis Healthcare
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Covered Entity Details
Entity Name
Roper St. Francis Healthcare
Subdivision Name
Roper St. Francis Health Services Center
Type
Sexually Transmitted Diseases
340B ID
STD294071
Entity Address
1481 Tobias Gadson Blvd, Suite 1
Charleston, SC 29407
Grant Number
NU62PS924531-03-00
Participating Start Date
10/1/2022
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
10/1/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kimberly Butler Willis, RW PROGRAM DIRECTOR
(843) 402-1067
Contract Pharmacy Representative
Avita Pharmacy
Lorrie Carr, CEO
(732) 546-2678
Signed By Date
10/1/2020
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