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LONGS DRUGS OF LEXINGTON
HV00657A Roper St. Francis Healthcare
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Covered Entity Details
Entity Name
Roper St. Francis Healthcare
Subdivision Name
Roper St. Francis Health Services Center
Type
Ryan White Part C
340B ID
HV00657A
Entity Address
730 Stoney Landing Rd
Ste 104
Moncks Corner, SC 29461
Grant Number
H76HA31742
Participating Start Date
7/1/2025
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
4/8/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tawana Faye Philpott Brown, Program Director
(843) 402-1981
Contract Pharmacy Representative
Avita Pharmacy
Trista Ciotola, District Manager
(570) 956-6404
Signed By Date
4/8/2025
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