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LONGS DRUGS OF LEXINGTON
STD30633 MADISON COUNTY HEALTH DEPARTMENT
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Covered Entity Details
Entity Name
MADISON COUNTY HEALTH DEPARTMENT
Subdivision Name
DISTRICT 10
Type
Sexually Transmitted Diseases
340B ID
STD30633
Entity Address
1424 HWY 98 W
DANIELSVILLE, GA 30633
Grant Number
NH25PS005184
Participating Start Date
1/1/2000
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
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Latasha Terry, STD Director
(678) 644-5464
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
10/15/2020
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