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LONGS DRUGS OF LEXINGTON
RWII29601A AID Upstate
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Covered Entity Details
Entity Name
AID Upstate
Subdivision Name
Type
Ryan White Part B
340B ID
RWII29601A
Entity Address
118 Montgomery Drive
Anderson, SC 29621
Grant Number
X07HA00038
Participating Start Date
4/1/2016
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
Roshan McDaniel, SC ADAP Director
(803) 898-0703
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
10/14/2016
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