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LONGS DRUGS OF LEXINGTON
STD606131 Center on Halsted
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Covered Entity Details
Entity Name
Center on Halsted
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD606131
Entity Address
3656 N Halsted St
Chicago, IL 60613
Grant Number
NH25PS005128
Participating Start Date
6/15/2023
Last Recertification Date
5/9/2025
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
6/15/2023
Contract Begin Date
6/15/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Editha Paras, Interim Chief Executive Officer
(773) 472-6469
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/7/2023
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