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LONGS DRUGS OF LEXINGTON
STD33032 Family Behavioral Health Services
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Covered Entity Details
Entity Name
Family Behavioral Health Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33032
Entity Address
15260 SW 280th Street
Suite 205
Homestead, FL 33032
Grant Number
5NU62PS92453202
Participating Start Date
10/1/2021
Last Recertification Date
5/22/2023
Entity Termination Date
7/1/2024
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
11/29/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jose Ramon Rodriguez-Diaz, 340B Administrator
(939) 545-0522
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
11/29/2021
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