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LONGS DRUGSTORES OF SC INC
RWII29601 AID Upstate
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Covered Entity Details
Entity Name
AID Upstate
Subdivision Name
Type
Ryan White Part B
340B ID
RWII29601
Entity Address
811 Pendleton St, Suite 10 & 11
Greenville, SC 29601
Grant Number
X07HA00038
Participating Start Date
10/1/2009
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
LONGS DRUGSTORES OF SC INC
Pharmacy Address
D/B/A AVITA PHARMACY 1054
455 LAKESHORE PKWY
ROCK HILL, SC 29730-4205
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
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 PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/16/2018
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