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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11251
2531 CUTHBERTSON RD.
WAXHAW, NC 28173
Pharmacy Comments
Contract Details
Approval Date
10/5/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Olivia Bentley, Executive Director
(704) 968-8353
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/5/2021
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