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LONGS DRUGS OF LEXINGTON
CH06101A MARTIN LUTHER KING JR FAMILY CLINIC INC
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Covered Entity Details
Entity Name
MARTIN LUTHER KING JR FAMILY CLINIC INC
Subdivision Name
Foremost Family Health Center - Balch Springs
Type
HRSA-Funded Health Center
340B ID
CH06101A
Entity Address
3515 Shepherd Ln
Balch Springs, TX 75180-2325
Grant Number
H80CS00127
Participating Start Date
1/1/2015
Last Recertification Date
2/10/2025
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
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOYCE E. TAPLEY, CEO
(469) 601-9360
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/16/2023
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