Contract Pharmacy Details

NORTH CAROLINA CVS PHARMACY, L.L.C.
RWI282050 Charlotte Health Initiative

Covered Entity Details

Entity Name

Charlotte Health Initiative

Subdivision Name

Type

Ryan White Part A

340B ID

RWI282050

Entity Address

4115 The Plaza
Charlotte, NC 28205

Grant Number

H89HA11434

Participating Start Date

4/1/2018

Last Recertification Date

2/4/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

NORTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07407
6110 THE PLAZA
CHARLOTTE, NC 28215

Pharmacy Comments

Contract Details

Approval Date

7/2/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Tagbo Ekwonu, President
(704) 307-8589

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/2/2018

340B Drug Pricing Program Database