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LONGS DRUGS OF LEXINGTON
STD60608 Alliance Care 360
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Covered Entity Details
Entity Name
Alliance Care 360
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD60608
Entity Address
2929 S Wabash Avenue,
Suite
202
Chicago, IL 60616-2327
Grant Number
1-NU62PS924733-01-00
Participating Start Date
8/30/2021
Last Recertification Date
5/8/2025
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
10/5/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ariq Cabbler, Director
(312) 808-1044 Ext: 101
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/5/2021
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