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LONGS DRUGS OF LEXINGTON
FP392020 My Brother's Keeper, Inc
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Covered Entity Details
Entity Name
My Brother's Keeper, Inc
Subdivision Name
Open Arms Healthcare Center
Type
Family Planning (Title X only)
340B ID
FP392020
Entity Address
805 East River Place
Jackson, MS 39202
Grant Number
FPHPA006550
Participating Start Date
10/1/2018
Last Recertification Date
5/7/2025
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
4/30/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
June Gipson, CEO
(769) 216-2455
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/30/2021
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