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LONGS DRUGS OF LEXINGTON
STD39216 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
Sexually Transmitted Diseases
340B ID
STD39216
Entity Address
805 E. River Place
Jackson, MS 39206
Grant Number
NU65PS923762
Participating Start Date
4/1/2014
Last Recertification Date
5/6/2025
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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