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LONGS DRUGS OF LEXINGTON
STD46226 DAMIEN CENTER INC, THE
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Covered Entity Details
Entity Name
DAMIEN CENTER INC, THE
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD46226
Entity Address
8902 E 38th St.
Indianapolis, IN 46226
Grant Number
NU62PS924556
Participating Start Date
4/1/2021
Last Recertification Date
5/5/2025
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
4/8/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alan Witchey, President and CEO
(317) 632-0123 Ext: 266
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
4/8/2021
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