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LONGS DRUGS OF LEXINGTON
FP581077 FARGO CASS PUBLIC HEALTH
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Covered Entity Details
Entity Name
FARGO CASS PUBLIC HEALTH
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP581077
Entity Address
1240 25th Street South
FARGO, ND 58103
Grant Number
5 FPHPA006519-04-00
Participating Start Date
1/1/1998
Last Recertification Date
5/7/2025
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
12/20/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/27/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Desi H Fleming, Director
(701) 241-1380
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
12/20/2022
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