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LONGS DRUGS OF LEXINGTON
STD75219 Resource Center of Dallas
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Covered Entity Details
Entity Name
Resource Center of Dallas
Subdivision Name
Health Campus
Type
Sexually Transmitted Diseases
340B ID
STD75219
Entity Address
2603 Inwood
Dallas, TX 75235
Grant Number
NH25PS005182
Participating Start Date
4/1/2018
Last Recertification Date
5/5/2025
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
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marisa Elliott, Chief Operating Officer
(214) 540-4454
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/14/2022
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