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LONGS DRUGS OF LEXINGTON
STD3280613 Sunshine Specialty Health Outreach Foundation
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Covered Entity Details
Entity Name
Sunshine Specialty Health Outreach Foundation
Subdivision Name
Delta Internal Medicine Center
Type
Sexually Transmitted Diseases
340B ID
STD3280613
Entity Address
220 E. Gore Street
Suite 202
Orlando, FL 32806
Grant Number
5NU62PS9224532-02
Participating Start Date
4/1/2024
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
4/4/2025
Contract Begin Date
4/4/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/7/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jillian Hall, President
(407) 325-1299
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/4/2025
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