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LONGS DRUGS OF LEXINGTON
STD292017 Joseph H Neal Health Collaborative
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Covered Entity Details
Entity Name
Joseph H Neal Health Collaborative
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD292017
Entity Address
1107 State Street
Cayce, SC 29033-4342
Grant Number
NH25PS004378
Participating Start Date
4/1/2021
Last Recertification Date
5/9/2025
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
6/6/2021
Contract Begin Date
6/8/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Frazier Ben Beatty, Interim Executive Director
(803) 386-0475 Ext: 1004
Contract Pharmacy Representative
Avita Specialty Pharmacy
Karla Sisinni, Regional 340B Consultant
(814) 323-4229
Signed By Date
6/6/2021
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