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LONGS DRUGS OF LEXINGTON
RWII49008A Community AIDS Resource and Education Services of Southwest Michigan
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Covered Entity Details
Entity Name
Community AIDS Resource and Education Services of Southwest Michigan
Subdivision Name
Benton Harbor Location
Type
Ryan White Part B
340B ID
RWII49008A
Entity Address
185 East Main Street
Benton Harbor, MI 49022
Grant Number
X07HA00044
Participating Start Date
7/1/2018
Last Recertification Date
2/10/2025
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
1/14/2021
Contract Begin Date
2/8/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly A. Doyle, CEO
(269) 806-3970
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/14/2021
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