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LONGS DRUGS OF LEXINGTON
STD70820 Byja Charitable Alliance, Inc.
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Covered Entity Details
Entity Name
Byja Charitable Alliance, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD70820
Entity Address
7170 Burbank Drive - Suite B1
Baton Rouge, LA 70820
Grant Number
NH25PS005176
Participating Start Date
10/1/2023
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
9/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Byron Jasper, President
(225) 320-5090
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/17/2023
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