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LONGS DRUGS OF LEXINGTON
STD49646 District Health Department #10
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Covered Entity Details
Entity Name
District Health Department #10
Subdivision Name
Kalkaska location
Type
Sexually Transmitted Diseases
340B ID
STD49646
Entity Address
625 Courthouse DR
Kalkaska, MI 49646
Grant Number
NH25PS005170
Participating Start Date
1/1/2021
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
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sheila Parker, Clinical Supervisor
(231) 236-7588
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
4/11/2025
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