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LONGS DRUGS OF LEXINGTON
HV01710C AIDS Arms, Inc., d/b/a Prism Health North Texas
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Covered Entity Details
Entity Name
AIDS Arms, Inc., d/b/a Prism Health North Texas
Subdivision Name
Oak Lawn Health Center
Type
Ryan White Part C
340B ID
HV01710C
Entity Address
2801 Lemmon Ave
Suite 200
Dallas, TX 75204
Grant Number
H76HA01710
Participating Start Date
10/1/2019
Last Recertification Date
3/3/2025
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
10/20/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John T. Carlo, CEO
(214) 521-5191
Contract Pharmacy Representative
Avita Drugs
KEITH FOX, CFO
(225) 236-1540
Signed By Date
10/20/2021
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