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LONGS DRUGS OF LEXINGTON
STD48103 Planned Parenthood of Michigan
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Covered Entity Details
Entity Name
Planned Parenthood of Michigan
Subdivision Name
Ann Arbor West Health Center
Type
Sexually Transmitted Diseases
340B ID
STD48103
Entity Address
2370 W Stadium Blvd
Ann Arbor, MI 48103
Grant Number
NH25PS005170
Participating Start Date
4/1/2018
Last Recertification Date
5/24/2024
Entity Termination Date
7/1/2025
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
7/7/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Denise Thal, EVP & CFO
(734) 926-4828
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/7/2021
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