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LONGS DRUGS OF LEXINGTON
STD33016 Doctors United Group Inc
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Covered Entity Details
Entity Name
Doctors United Group Inc
Subdivision Name
Doctors United Group Inc hialeah
Type
Sexually Transmitted Diseases
340B ID
STD33016
Entity Address
2150 W 76th street
suite 100
hialeah, FL 33016
Grant Number
NH25PS004342
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
10/8/2021
Contract Begin Date
10/18/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Augustine Carbon, President
(305) 788-0007
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/8/2021
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