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LONGS DRUGS OF LEXINGTON
STD061064 Connecticut Children's Specialty Group
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Covered Entity Details
Entity Name
Connecticut Children's Specialty Group
Subdivision Name
Infectious Disease Clinic
Type
Sexually Transmitted Diseases
340B ID
STD061064
Entity Address
282 Washington St
Hartford, CT 06106
Grant Number
6 NU62PS924521-04-02
Participating Start Date
10/1/2021
Last Recertification Date
5/6/2025
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
7/5/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Danielle Warren-Dias, Program Coordinator
(860) 525-4006
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/5/2022
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