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LONGS DRUGS OF LEXINGTON
STD496860 PLANNED PARENTHOOD MICHIGAN
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Covered Entity Details
Entity Name
PLANNED PARENTHOOD MICHIGAN
Subdivision Name
TRAVERSE CITY CLINIC
Type
Sexually Transmitted Diseases
340B ID
STD496860
Entity Address
1135 E EIGHTH STREET
TRAVERSE CITY, MI 49686
Grant Number
NH25PS005170
Participating Start Date
1/1/2007
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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