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LONGS DRUGS OF LEXINGTON
STD606441 Taskforce Prevention and Community Services
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Covered Entity Details
Entity Name
Taskforce Prevention and Community Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD606441
Entity Address
9 N Cicero Ave
Chicago, IL 60644
Grant Number
NU62PS924733
Participating Start Date
4/1/2023
Last Recertification Date
5/28/2025
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
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Balthazar, Executive Director
(504) 432-5420
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
4/15/2025
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