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LONGS DRUGS OF LEXINGTON
STD551141 Rainbow Health Minnesota
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Covered Entity Details
Entity Name
Rainbow Health Minnesota
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD551141
Entity Address
701 S 4th Ave
Ste. 1500
Minneapolis, MN 55415
Grant Number
6 NH25PS005172
Participating Start Date
10/1/2023
Last Recertification Date
5/6/2024
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
2/18/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeremy James Hanson Willis, CEO
(612) 373-2400 Ext: 6123065274
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/15/2021
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