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LONGS DRUGS OF LEXINGTON
STD303035 Empowerment Resource Center
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Covered Entity Details
Entity Name
Empowerment Resource Center
Subdivision Name
Comprehensive Intervention Clinic
Type
Sexually Transmitted Diseases
340B ID
STD303035
Entity Address
230 Peachtree St NW
Suite 1800
Atlanta, GA 30303-1514
Grant Number
5NH25PS004329-04-00
Participating Start Date
10/1/2013
Last Recertification Date
5/6/2025
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
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jacqueline Brown, Chief Executive Officer
(404) 526-1145
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
4/12/2018
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