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LONGS DRUGS OF LEXINGTON
STD78520 Valley AIDS Council
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Covered Entity Details
Entity Name
Valley AIDS Council
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78520
Entity Address
857 E Washington
Brownsville, TX 78520
Grant Number
NU62PS924529
Participating Start Date
1/1/2020
Last Recertification Date
5/13/2025
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
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wally Cantu, Executive Director
(956) 428-2653
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/15/2021
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