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LONGS DRUGS OF LEXINGTON
STD495035 Planned Parenthood of Michigan
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Covered Entity Details
Entity Name
Planned Parenthood of Michigan
Subdivision Name
Grand Rapids Health Center
Type
Sexually Transmitted Diseases
340B ID
STD495035
Entity Address
425 CHERRY STREET
GRAND RAPIDS, MI 49503
Grant Number
NH25PS005170
Participating Start Date
1/1/2005
Last Recertification Date
5/5/2025
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
7/11/2021
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
7/11/2021
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