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LONGS DRUGS OF LEXINGTON
STD47421 Pace Community Action Agency - Health Connection Bedford
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Covered Entity Details
Entity Name
Pace Community Action Agency - Health Connection Bedford
Subdivision Name
Health Connection
Type
Sexually Transmitted Diseases
340B ID
STD47421
Entity Address
2119 16th Street
Bedford, IN 47421
Grant Number
5 NH25PS005139
Participating Start Date
10/1/2019
Last Recertification Date
5/5/2025
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
1/8/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michelle Pitcher, Clinical Services Director
(812) 882-7927 Ext: 1224
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
1/8/2025
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