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LONGS DRUGS OF LEXINGTON
RWII56304 Rural AIDS Action Network
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Covered Entity Details
Entity Name
Rural AIDS Action Network
Subdivision Name
Type
Ryan White Part B
340B ID
RWII56304
Entity Address
300 E St Germain Street
Ste 220
St Cloud, MN 56304
Grant Number
X07HA00043-30
Participating Start Date
7/1/2016
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
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Margaret McCarthy, Executive Director
(320) 209-1191
Contract Pharmacy Representative
Avita
Jennifer Jabben, PharmD, AAHIVP
(620) 330-6855
Signed By Date
1/16/2024
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