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LONGS DRUGS OF LEXINGTON
STD598026 Blue Mountain Clinic
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Covered Entity Details
Entity Name
Blue Mountain Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD598026
Entity Address
610 N. California St
Missoula, MT 59802
Grant Number
6 NH25PS005168-05-06
Participating Start Date
4/1/2022
Last Recertification Date
5/12/2025
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
4/13/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nicole Kristine Smith, Executive Director
(406) 541-4378
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/10/2023
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