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LONGS DRUGS OF LEXINGTON
CH09900F EAST VALLEY COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
EAST VALLEY COMMUNITY HEALTH CENTER INC
Subdivision Name
EVCHC - Palomares SBC
Type
HRSA-Funded Health Center
340B ID
CH09900F
Entity Address
2211 North Orange Grove Avenue
Pomona, CA 91767-2319
Grant Number
H80CS00286
Participating Start Date
4/1/2017
Last Recertification Date
2/12/2025
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
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALICIA MARDINI, CEO
(626) 919-4333 Ext: 2220
Contract Pharmacy Representative
PharmedQuest
Leslie Stone, Account Manager
(714) 364-4683
Signed By Date
10/13/2020
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