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WALGREENS SPECIALTY PHARMACY, LLC
RWI20825B Amity Medical Group, Inc
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Covered Entity Details
Entity Name
Amity Medical Group, Inc
Subdivision Name
AMG3 Monroe Rd location
Type
Ryan White Part A
340B ID
RWI20825B
Entity Address
9835 Monroe Rd
Suite B
Charlotte, NC 28270
Grant Number
H89HA11434
Participating Start Date
4/1/2021
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
3/11/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Olivia Bentley, Executive Director
(704) 968-8353
Contract Pharmacy Representative
Walgreens
Danielle S Jones, Account Analyst
(847) 964-6725
Signed By Date
3/10/2021
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