Contract Pharmacy Details

LONGS DRUGS OF LEXINGTON
RWII97403A HIV Alliance

Covered Entity Details

Entity Name

HIV Alliance

Subdivision Name

Jackson County Office

Type

Ryan White Part B

340B ID

RWII97403A

Entity Address

955 Town Centre Drive
B
Medford, OR 97504

Grant Number

X07HA00007

Participating Start Date

4/1/2020

Last Recertification Date

2/12/2025

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

7/15/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Renee Yandel, Executive Director
(541) 342-5088 Ext: 118

Contract Pharmacy Representative

PharMedQuest
Meera Hasolkar, Director of Pharmacy Operations
(714) 364-4008

Signed By Date

7/15/2021

340B Drug Pricing Program Database