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LONGS DRUGS OF LEXINGTON
HV042580C Health Services Center, Inc.
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Covered Entity Details
Entity Name
Health Services Center, Inc.
Subdivision Name
Type
Ryan White Part C
340B ID
HV042580C
Entity Address
3205 20th Ave
Valley, AL 36854
Grant Number
H76HA00094
Participating Start Date
1/1/2021
Last Recertification Date
2/6/2024
Entity Termination Date
4/1/2025
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
4/7/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jennae Young, Director
(256) 832-0100 Ext: 304
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/7/2022
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