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CYSTIC FIBROSIS SERVICES, LLC
RWI20825 Amity Medical Group, Inc
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Covered Entity Details
Entity Name
Amity Medical Group, Inc
Subdivision Name
AMG1 Harris Blvd location
Type
Ryan White Part A
340B ID
RWI20825
Entity Address
6010 EAST W T HARRIS BLVD
CHARLOTTE, NC 28215-4084
Grant Number
H89HA11434
Participating Start Date
10/1/2016
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
1/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Olivia Bentley, Dr.
(704) 246-5131
Contract Pharmacy Representative
Walgreens
Danielle S Jones, Account Analyst
(847) 964-6725
Signed By Date
1/12/2021
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