Contract Pharmacy Details

LONGS DRUGS OF LEXINGTON
RWI200110 Andromeda Transcultural Health

Covered Entity Details

Entity Name

Andromeda Transcultural Health

Subdivision Name

Type

Ryan White Part A

340B ID

RWI200110

Entity Address

1400 Decatur St. NW
Washington, DC 20011

Grant Number

H89HA00012

Participating Start Date

7/1/2018

Last Recertification Date

2/4/2022

Entity Termination Date

4/1/2023

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

10/21/2020

Contract Begin Date

10/28/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Alvaro Guzman, Executive Director
(202) 291-4707 Ext: 128

Contract Pharmacy Representative

PharmBlue
karla sisinni, Pharmacist
(814) 323-4229

Signed By Date

10/21/2020

340B Drug Pricing Program Database