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LONGS DRUGS OF LEXINGTON
HV00657 Roper St. Francis Healthcare
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Covered Entity Details
Entity Name
Roper St. Francis Healthcare
Subdivision Name
Roper St. Francis Health Services Center
Type
Ryan White Part C
340B ID
HV00657
Entity Address
1481 Tobias Gadson Blvd, Suite 1
CHARLESTON, SC 29407
Grant Number
H76HA31742
Participating Start Date
7/1/2007
Last Recertification Date
2/10/2025
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
12/2/2022
Contract Begin Date
12/2/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tawana Faye Philpott Brown, Program Director
(843) 402-1981
Contract Pharmacy Representative
Avita Pharmacy
Keith Fox, Sr. Vice President
(225) 236-1540
Signed By Date
12/2/2022
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