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LONGS DRUGS OF LEXINGTON
STD94610 Oakland LGBTQ Community Center
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Covered Entity Details
Entity Name
Oakland LGBTQ Community Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD94610
Entity Address
3207 Lakeshore Ave
Oakland, CA 94610
Grant Number
1H25PS005127
Participating Start Date
4/1/2023
Last Recertification Date
5/6/2025
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
4/10/2023
Contract Begin Date
4/17/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maurice Tobin, Testing And Treatment Manager
(510) 882-2286
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/10/2023
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