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LONGS DRUGS OF LEXINGTON
STD084011 South Jersey AIDS Alliance
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Covered Entity Details
Entity Name
South Jersey AIDS Alliance
Subdivision Name
Oasis
Type
Sexually Transmitted Diseases
340B ID
STD084011
Entity Address
32 S. Tennessee Avenue
Atlantic City, NJ 08401
Grant Number
NH25PS005174
Participating Start Date
1/1/2019
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
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Babette J Richter, ARCH Nurse Team Leader
(609) 572-1929
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/13/2023
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