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WALMART PHARMACY 10-4148
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
WALMART PHARMACY 10-4148
Pharmacy Address
8800 EAST WT HARRIS BLVD
CHARLOTTE, NC 28227
Pharmacy Comments
Contract Details
Approval Date
4/13/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Olivia Bentley, Executive Director
(704) 968-8353
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2022
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