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LONGS DRUGS OF LEXINGTON
RWII29302 Piedmont Care, Inc.
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Covered Entity Details
Entity Name
Piedmont Care, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII29302
Entity Address
101 North Pine Street, Suite 200
Spartanburg, SC 29302
Grant Number
X07HA00038
Participating Start Date
1/1/2014
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
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tracey L. Jackson, Executive Director
(864) 582-7773 Ext: 8642744178
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
10/14/2016
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