Contract Pharmacy Details

NORTH CAROLINA CVS PHARMACY, L.L.C.
RWI20825B Amity Medical Group, Inc

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

NORTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06406
3126 DALLAS-HIGH SHOALS HWY.
DALLAS, NC 28034

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

11/6/2023
Pharmacy closed

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

340B Drug Pricing Program Database