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LONGS DRUGS OF LEXINGTON
RWII19801 AIDS Delaware Inc
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Covered Entity Details
Entity Name
AIDS Delaware Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII19801
Entity Address
100 West 10th Street, Suite 315
Wilmington, DE 19801
Grant Number
5 X07HA00081-31-00
Participating Start Date
7/1/2013
Last Recertification Date
2/11/2025
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
1/5/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John P. Gardner, Executive Director
(302) 652-6776 Ext: 206
Contract Pharmacy Representative
Avita
Kaitlin Thomas, 340 B Regional Manager
(918) 859-6551
Signed By Date
1/5/2023
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