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LONGS DRUGS OF LEXINGTON
HV49237 AIDS Ministries AIDS Assist of North Indiana INC
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Covered Entity Details
Entity Name
AIDS Ministries AIDS Assist of North Indiana INC
Subdivision Name
Type
Ryan White Part C
340B ID
HV49237
Entity Address
201 S William St
South Bend, IN 46601-2514
Grant Number
H76HA49237
Participating Start Date
4/1/2024
Last Recertification Date
2/19/2025
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
10/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leeah Hopper, Executive Director
(574) 234-2870
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
10/8/2024
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