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LONGS DRUGS OF LEXINGTON
RWI200091A District of Columbia Department of Health
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Covered Entity Details
Entity Name
District of Columbia Department of Health
Subdivision Name
Us Helping Us, People Into Living, Inc.
Type
Ryan White Part A
340B ID
RWI200091A
Entity Address
3636 Georgia Avenue NW
Washington, DC 20010
Grant Number
H89HA00012
Participating Start Date
8/16/2022
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
7/26/2022
Contract Begin Date
8/16/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DeMarc Anthony Hickson, Executive Director
(202) 446-1100 Ext: 1092
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/15/2022
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