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LONGS DRUGS OF LEXINGTON
STD900222 Bienestar Human Services, Inc
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Covered Entity Details
Entity Name
Bienestar Human Services, Inc
Subdivision Name
HIV & STD Programs
Type
Sexually Transmitted Diseases
340B ID
STD900222
Entity Address
5326 E BEVERLY BLVD
LOS ANGELES, CA 90022-2104
Grant Number
NH25PS005130
Participating Start Date
7/1/2021
Last Recertification Date
5/26/2025
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
5/5/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Contreras, President & CEO
(323) 545-6577
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/15/2021
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