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LONGS DRUGS OF LEXINGTON
STD805241 Colorado Health Network, Inc.
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Covered Entity Details
Entity Name
Colorado Health Network, Inc.
Subdivision Name
Northern Region
Type
Sexually Transmitted Diseases
340B ID
STD805241
Entity Address
400 Remington St., Ste. 100
Fort Collins, CO 80524
Grant Number
NU62PS924563
Participating Start Date
1/1/2021
Last Recertification Date
5/6/2025
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
11/20/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Darrell J Vigil, Chief Executive Officer
(303) 837-0166
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
10/5/2020
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