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LONGS DRUGS OF LEXINGTON
STD22408 FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
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Covered Entity Details
Entity Name
FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD22408
Entity Address
4343 Plank Road
SUITE 100
FREDERICKSBURG, VA 22407
Grant Number
NU62PS924552
Participating Start Date
10/1/2017
Last Recertification Date
5/7/2025
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
7/20/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen James Clark, Grants Manager
(540) 371-7532 Ext: 123
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
7/20/2017
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