Contract Pharmacy Details

LONGS DRUGS OF LEXINGTON
CHC28966-03 Kansas City CARE Clinic

Covered Entity Details

Entity Name

Kansas City CARE Clinic

Subdivision Name

Kansas City CARE Clinic

Type

HRSA-Funded Health Center

340B ID

CHC28966-03

Entity Address

1106 E 30th St Ste B
Kansas City, MO 64109-1507

Grant Number

H80CS28966

Participating Start Date

1/1/2020

Last Recertification Date

2/15/2022

Entity Termination Date

4/1/2023

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

4/16/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Dennis Dunmyer, Chief Operating Officer
(816) 777-2726

Contract Pharmacy Representative

AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587

Signed By Date

4/16/2021

340B Drug Pricing Program Database