Contract Pharmacy Details

WALGREEN CO.
RWI20825A Amity Medical Group, Inc

Covered Entity Details

Entity Name

Amity Medical Group, Inc

Subdivision Name

AMG2 Park Rd location

Type

Ryan White Part A

340B ID

RWI20825A

Entity Address

10508 Park Rd Suite 130
Charlotte, NC 28210

Grant Number

H89HA11434

Participating Start Date

7/1/2019

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS #16087
9428 STEELE CREEK RD.
CHARLOTTE, NC 28273

Pharmacy Comments

Contract Details

Approval Date

7/7/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Olivia Bentley, Dr.
(704) 246-5131

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/7/2020

340B Drug Pricing Program Database