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LONGS DRUGS OF LEXINGTON
RWII779010 Crossroads Virology
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Covered Entity Details
Entity Name
Crossroads Virology
Subdivision Name
Type
Ryan White Part B
340B ID
RWII779010
Entity Address
1403 Victoria Station Dr.
Victoria, TX 77901
Grant Number
X07HA00054
Participating Start Date
7/20/2020
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
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paige A Boehm, Clinic Manager
(361) 571-7956
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/15/2024
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