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LONGS DRUGS OF LEXINGTON
STD770362 Fundacion Latinoamericana De Accion Social, Inc.
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Covered Entity Details
Entity Name
Fundacion Latinoamericana De Accion Social, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD770362
Entity Address
6666 Harwin Dr.370 Houston, TX. 77036
370
370
Houston, TX 77036-2264
Grant Number
NU62PS924719
Participating Start Date
10/1/2021
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
10/7/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elia Chino, Executive Director
(713) 772-2366
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/7/2021
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