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LONGS DRUGS OF LEXINGTON
STD333112 WellView Care
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Covered Entity Details
Entity Name
WellView Care
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD333112
Entity Address
906 WEST SUNRISE BLVD
A
Fort Lauderdale, FL 33311
Grant Number
NH25PS005131
Participating Start Date
4/1/2021
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
10/11/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Adolfo Lorenzo, President
(305) 491-3600
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/11/2022
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