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LONGS DRUGS OF LEXINGTON
STD130692 OSWEGO COUNTY OPPORTUNITIES - FULTON HEALTH CENTER
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Covered Entity Details
Entity Name
OSWEGO COUNTY OPPORTUNITIES - FULTON HEALTH CENTER
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD130692
Entity Address
522 South Fourth Street
Suite 500
FULTON, NY 13069
Grant Number
6NH25PS005175
Participating Start Date
7/1/2019
Last Recertification Date
5/16/2023
Entity Termination Date
7/1/2024
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
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Leanna K Cleveland, Director of Health & Nutrition Services
(315) 529-8329
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/4/2023
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