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LONGS DRUGS OF LEXINGTON
RWI28078 ROSEDALE HEALTH AND WELLNESS
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Covered Entity Details
Entity Name
ROSEDALE HEALTH AND WELLNESS
Subdivision Name
Type
Ryan White Part A
340B ID
RWI28078
Entity Address
103 COMMERCE CENTRE DRIVE
SUITE 103
HUNTERSVILLE, NC 28078
Grant Number
H89HA11434
Participating Start Date
7/1/2024
Last Recertification Date
2/10/2025
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
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Frederick A. Cruickshank, Medical Director
(704) 659-7276
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
10/17/2016
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