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LONGS DRUGS OF LEXINGTON
STD941031 San Francisco AIDS Foundation
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Covered Entity Details
Entity Name
San Francisco AIDS Foundation
Subdivision Name
1035 Satellite Clinic
Type
Sexually Transmitted Diseases
340B ID
STD941031
Entity Address
1035 Market Street, Suite 400
San Francisco, CA 94103
Grant Number
6NH25PS005141
Participating Start Date
4/1/2015
Last Recertification Date
5/10/2023
Entity Termination Date
4/1/2024
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
10/13/2022
Contract Begin Date
10/21/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Chris Damon, Controller
(415) 487-3043
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/13/2022
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