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LONGS DRUGS OF LEXINGTON
STD27403 Triad Health Project
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Covered Entity Details
Entity Name
Triad Health Project
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD27403
Entity Address
801 Summit Avenue
Greensboro, NC 27405
Grant Number
6 NH25PS005152-02-01
Participating Start Date
4/1/2021
Last Recertification Date
5/9/2025
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
4/13/2021
Contract Begin Date
4/19/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Cassity, Executive Director
(336) 275-1654
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/13/2021
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