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LONGS DRUGS OF LEXINGTON
RWII352223B AIDS Alabama
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Covered Entity Details
Entity Name
AIDS Alabama
Subdivision Name
Living Well Clinic
Type
Ryan White Part B
340B ID
RWII352223B
Entity Address
3522 7th Avenue South
Birmingham, AL 35222
Grant Number
X07HA00049
Participating Start Date
1/1/2021
Last Recertification Date
2/14/2025
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
11/30/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katherine Elizabeth McMullen, Director of Programs Administration
(205) 918-8196
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
10/13/2020
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