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LONGS DRUGS OF LEXINGTON
RWI30311 Heather Ivy Society
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Covered Entity Details
Entity Name
Heather Ivy Society
Subdivision Name
Heather Ivy Society
Type
Ryan White Part A
340B ID
RWI30311
Entity Address
2193 Cascade Road SW
Atlanta, GA 30311-2862
Grant Number
UT8HA33933
Participating Start Date
10/1/2023
Last Recertification Date
2/12/2025
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
4/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Zandraetta Tims-Cook, Executive Director
(844) 884-9691 Ext: 1
Contract Pharmacy Representative
Avita
Shawn Smith, Sr Account Executive
(305) 906-2937
Signed By Date
4/4/2024
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