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LONGS DRUGS OF LEXINGTON
RW424835D University of South Florida, College of Public Health
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Covered Entity Details
Entity Name
University of South Florida, College of Public Health
Subdivision Name
Positively U
Type
Ryan White Part D
340B ID
RW424835D
Entity Address
1419 West Waters Avenue
Suite 117
Tampa, FL 33604
Grant Number
H12HA24835
Participating Start Date
7/1/2016
Last Recertification Date
2/11/2025
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
11/16/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Janet Kitchen, Executive Director
(813) 857-2974
Contract Pharmacy Representative
Avita Pharmacy
Shawn Smith, Account Executive
(305) 906-2937
Signed By Date
11/16/2021
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