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LONGS DRUGS OF CHARLESTON
HV00657 Roper St. Francis Healthcare
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Covered Entity Details
Entity Name
Roper St. Francis Healthcare
Subdivision Name
Roper St. Francis Health Services Center
Type
Ryan White Part C
340B ID
HV00657
Entity Address
1481 Tobias Gadson Blvd, Suite 1
CHARLESTON, SC 29407
Grant Number
H76HA31742
Participating Start Date
7/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
LONGS DRUGS OF CHARLESTON
Pharmacy Address
DBA AVITA PHARMACY 1052
1481 TOBIAS GADSON BLVD STE 2D
CHARLESTON, SC 29407
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kimberly Butler Willis, RW PROGRAM DIRECTOR
(843) 402-1067
Contract Pharmacy Representative
Long's Drugs
Christi Epps, PharmD
(404) 270-9242
Signed By Date
10/16/2017
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