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LONGS DRUGS OF LEXINGTON
RWII55409 The Aliveness Project, Inc
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Covered Entity Details
Entity Name
The Aliveness Project, Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII55409
Entity Address
3808 Nicollet Avenue
Minneapolis, MN 55409
Grant Number
X07HA00028
Participating Start Date
1/1/2015
Last Recertification Date
2/18/2025
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
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matt Toburen, Executive Director
(612) 822-7946 Ext: 201
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/14/2021
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