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LONGS DRUGS OF LEXINGTON
STD70816 Grace House of Baton Rouge, Inc.
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Covered Entity Details
Entity Name
Grace House of Baton Rouge, Inc.
Subdivision Name
Grace Healthcare and Medical Solution Center
Type
Sexually Transmitted Diseases
340B ID
STD70816
Entity Address
9800 Airline Hwy
Suite
105
Baton Rouge, LA 70816
Grant Number
5NU62PS924522
Participating Start Date
10/1/2024
Last Recertification Date
5/13/2025
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
8/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ebony Brown, Chief Executive Officer
(833) 262-1101
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/11/2024
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