Contract Pharmacy Details

LONGS DRUGS OF LEXINGTON
RWI92354A Loma Linda University

Covered Entity Details

Entity Name

Loma Linda University

Subdivision Name

Infectious Disease

Type

Ryan White Part A

340B ID

RWI92354A

Entity Address

81 South Highland Springs Ave.
Suite 303
Beaumont, CA 92223

Grant Number

UT8HA33958

Participating Start Date

4/1/2025

Last Recertification Date

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

1/30/2025

Contract Begin Date

4/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Travis Losey, Vice President for Research Affairs
(909) 558-8544

Contract Pharmacy Representative

PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000

Signed By Date

1/12/2025

340B Drug Pricing Program Database