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LONGS DRUGS OF LEXINGTON
STD294611 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
Sexually Transmitted Diseases
340B ID
STD294611
Entity Address
730 Stoney Landing Rd
Ste 104
Moncks Corner, SC 29461
Grant Number
NU62PS924531-03-00
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
5/27/2025
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
4/10/2025
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