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LONGS DRUGS OF LEXINGTON
STD334032 WHEAT Community Services
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Covered Entity Details
Entity Name
WHEAT Community Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD334032
Entity Address
1511 Prosperity Farms Road
Suite 200
Lake Park, FL 33403-2614
Grant Number
NH25PS005131
Participating Start Date
6/16/2021
Last Recertification Date
6/2/2025
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
5/14/2021
Contract Begin Date
6/16/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Regina F Cooper, Director
(954) 661-7227
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/15/2021
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