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LONGS DRUGS OF LEXINGTON
STD294053 Lowcountry AIDS Services
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Covered Entity Details
Entity Name
Lowcountry AIDS Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD294053
Entity Address
5064 Rivers Ave
North Charleston, SC 29406
Grant Number
5H25PS004378
Participating Start Date
7/1/2017
Last Recertification Date
5/9/2025
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
4/24/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
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