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LONGS DRUGS OF LEXINGTON
STD277011 Triangle Empowerment Center, Inc.
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Covered Entity Details
Entity Name
Triangle Empowerment Center, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD277011
Entity Address
112 Broadway St.
Suite B
Durham, NC 27701
Grant Number
6 NH25PS005152-05-07
Participating Start Date
7/26/2022
Last Recertification Date
5/19/2025
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
8/31/2022
Contract Begin Date
8/31/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ronney Miguel Hunter, Executive Director
(800) 806-3558
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
8/31/2022
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