340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
LONGS DRUGS OF LEXINGTON
RWII28470 Life Changers Intervention Services LLC
Print
Covered Entity Details
Entity Name
Life Changers Intervention Services LLC
Subdivision Name
Type
Ryan White Part B
340B ID
RWII28470
Entity Address
5039 Main Street
Suite 2
Shallotte, NC 28470
Grant Number
X07HA00051
Participating Start Date
7/21/2022
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
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Beverly Stanley, CEO/Executive Director
(910) 754-7988
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
10/17/2016
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session