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LONGS DRUGS OF LEXINGTON
RWI4410A Nueva Luz Urban Resource Center
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Covered Entity Details
Entity Name
Nueva Luz Urban Resource Center
Subdivision Name
Type
Ryan White Part A
340B ID
RWI4410A
Entity Address
221 West 21st Street
#6
Lorain, OH 44052
Grant Number
H89HA23812
Participating Start Date
1/1/2020
Last Recertification Date
2/14/2025
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
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Max Rodas, Chief Executive Officer
(216) 857-0558
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/15/2022
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