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LONGS DRUGS OF LEXINGTON
STD274011 Piedmont Health Services and Sickle cell Agency
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Covered Entity Details
Entity Name
Piedmont Health Services and Sickle cell Agency
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD274011
Entity Address
1102 E. Market Street
Greensboro, NC 27401
Grant Number
1NU62PS924527
Participating Start Date
7/1/2021
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
4/26/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathy Moore Norcott, Executive
(336) 274-1507
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/12/2021
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