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RWI20825C Amity Medical Group, Inc (Active)
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Main Details
Name
Amity Medical Group, Inc
Subdivision Name
AMG4 Dallas location
Type
Ryan White Part A
340B ID
RWI20825C
Grant Number
H89HA11434
Additional Details
Current Program Status
Active
Registration Date
6/7/2022
Participating Start Date
6/9/2022
Participating Approval Date
6/9/2022
Last Recertification Date
2/13/2025
Time Period the Assistance was Received
3/1/2023 - 2/28/2026
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
824 Lower Dallas Hwy
Dallas, NC 28034
Billing Address
Amity Medical Group, Inc
6010 East W.T. Harris Blvd
A
Charlotte, NC 28215
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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