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LONGS DRUGS OF LEXINGTON
STD922621 PS Test, Inc
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Covered Entity Details
Entity Name
PS Test, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD922621
Entity Address
140 N Luring Dr
STE D
Palm Springs, CA 92262
Grant Number
1H25PS005127
Participating Start Date
7/1/2024
Last Recertification Date
5/8/2025
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
6/5/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Phyllis Ritchie, MD/CEO
(503) 307-5566
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/4/2024
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