Contract Pharmacy Details

LONGS DRUGS OF LEXINGTON
STD27262 Triad Health Project

Covered Entity Details

Entity Name

Triad Health Project

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD27262

Entity Address

501 W. Westwood Avenue
High Point, NC 27262

Grant Number

6 NH25PS005152-02-01

Participating Start Date

7/1/2021

Last Recertification Date

Entity Termination Date

7/1/2022

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

5/5/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2022
Covered Entity Terminated

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

4/15/2021

340B Drug Pricing Program Database