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LONGS DRUGS OF LEXINGTON
RWII292030 Prisma Health Medical Group - Midlands
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Covered Entity Details
Entity Name
Prisma Health Medical Group - Midlands
Subdivision Name
Division of Infectious Diseases
Type
Ryan White Part B
340B ID
RWII292030
Entity Address
1 Richland Medical Park
Suite 420
Columbia, SC 29203-6833
Grant Number
X07HA00038
Participating Start Date
10/1/2018
Last Recertification Date
2/10/2025
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
4/26/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roshan McDaniel, SC ADAP Director
(803) 898-0703
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/26/2022
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