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LONGS DRUGS OF LEXINGTON
RWI06114 Latino Community Services, Inc.
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Covered Entity Details
Entity Name
Latino Community Services, Inc.
Subdivision Name
Care & Support
Type
Ryan White Part A
340B ID
RWI06114
Entity Address
28 Grand Street 2nd FL
Hartford, CT 06106
Grant Number
H89HA00044
Participating Start Date
7/1/2017
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
4/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Madeline Rodriguez, Executive Director
(860) 296-6400 Ext: 238
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/10/2024
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