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LONGS DRUGS OF LEXINGTON
RWII22401 FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES INC.
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Covered Entity Details
Entity Name
FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES INC.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII22401
Entity Address
4343 Plank Road
Suite 100
FREDERICKSBURG, VA 22407
Grant Number
X07HA00009
Participating Start Date
4/1/2011
Last Recertification Date
2/13/2025
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
1/4/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MaryBeth K. Benz, Executive Director, FAHASS
(540) 907-4555 Ext: 205
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
1/4/2017
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