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LONGS DRUGS OF LEXINGTON
STD02118 Multicultural AIDS Coalition
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Covered Entity Details
Entity Name
Multicultural AIDS Coalition
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD02118
Entity Address
7 Palmer Street, 3rd Floor
Roxbury, MA 02119
Grant Number
6 NU62PS924700-01-01
Participating Start Date
4/1/2022
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
10/3/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary K. Daffin, Executive Director
(617) 840-8604
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/3/2022
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