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NORTH CAROLINA CVS PHARMACY, L.L.C.
RWI20825A Amity Medical Group, Inc
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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
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03823
1850 WEST FRANKLIN BOULEVARD
GASTONIA, NC 28052
Pharmacy Comments
Contract Details
Approval Date
9/8/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Olivia Bentley, Executive Director
(704) 968-8353
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
9/8/2022
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