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FQHCLA460E AMITY MEDICAL GROUP INC (Active)
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Main Details
Name
AMITY MEDICAL GROUP INC
Subdivision Name
AMG - Randolph Rd
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-038214
340B ID
FQHCLA460E
Grant Number
LALCS48999
Additional Details
Current Program Status
Active
Registration Date
10/8/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/10/2024
Last Recertification Date
2/13/2025
Contacts
Authorizing Official
Amity Medical Group, Inc
Olivia Bentley, Executive Director
(704) 968-8353
Primary Contact
Amity Medical Group
Amy Kern, Director of Pharmacy
(704) 575-6350
Addresses
Street Address
2300 Randolph Road
Charlotte, NC 28207-1127
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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