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LONGS DRUGS OF LEXINGTON
RWII198011 Delaware HIV Services, INC
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Covered Entity Details
Entity Name
Delaware HIV Services, INC
Subdivision Name
Type
Ryan White Part B
340B ID
RWII198011
Entity Address
100 W. 10th Street Suite 415
Wilmington, DE 19801
Grant Number
X07HA00081
Participating Start Date
10/1/2014
Last Recertification Date
2/14/2025
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
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brad Michael Shannon, Program Director
(302) 654-5471
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/17/2023
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