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LONGS DRUGS OF LEXINGTON
STD891231 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Henderson Clinic
Type
Sexually Transmitted Diseases
340B ID
STD891231
Entity Address
8420 South Eastern Avenue
101
Las Vegas, NV 89123
Grant Number
6 NH25PS005179-03-05
Participating Start Date
1/1/2022
Last Recertification Date
6/6/2022
Entity Termination Date
7/1/2023
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
7/8/2022
Contract Begin Date
8/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Vladimir Abadjiev, Operations Manager
(702) 526-3146
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/8/2022
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