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LONGS DRUGS OF LEXINGTON
RWI19107A ActionAIDS DBA Action Wellness
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Covered Entity Details
Entity Name
ActionAIDS DBA Action Wellness
Subdivision Name
Action Wellness West
Type
Ryan White Part A
340B ID
RWI19107A
Entity Address
3901 Market Street
#1934
Philadelphia, PA 19104
Grant Number
H89HA00013-33-030
Participating Start Date
1/1/2017
Last Recertification Date
2/14/2024
Entity Termination Date
7/1/2024
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
10/4/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kevin J. Burns, Executive Director
(215) 981-3338
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/4/2021
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