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LONGS DRUGS OF LEXINGTON
STD946212 Glenn Burke Wellness Clinic East Oakland
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Covered Entity Details
Entity Name
Glenn Burke Wellness Clinic East Oakland
Subdivision Name
Oakland LGBTQ Community Center
Type
Sexually Transmitted Diseases
340B ID
STD946212
Entity Address
8400 Enterprise Way,
Suite 120
Oakland, CA 94621
Grant Number
1H25PS005127
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
4/29/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maurice Tobin, Testing And Treatment Manager
(510) 882-2286
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
4/14/2025
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