340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
FOUNTAIN PLAZA PHARMACY DBA FOUNTAINRX
RWI20825A Amity Medical Group, Inc
Print
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
FOUNTAIN PLAZA PHARMACY DBA FOUNTAINRX
Pharmacy Address
2825 W. ANDREW JOHNSON HWY.
MORRISTOWN, TN 37814
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Olivia Bentley, Executive Director
(704) 968-8353
Contract Pharmacy Representative
Fountain Plaza Pharmacy
Joseph Huntsman, CEO
(423) 307-5757
Signed By Date
7/15/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session