Contract Pharmacy Details

WALGREEN CO.
RWI20825 Amity Medical Group, Inc

Covered Entity Details

Entity Name

Amity Medical Group, Inc

Subdivision Name

AMG1 Harris Blvd location

Type

Ryan White Part A

340B ID

RWI20825

Entity Address

6010 EAST W T HARRIS BLVD
CHARLOTTE, NC 28215-4084

Grant Number

H89HA11434

Participating Start Date

10/1/2016

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #21284
200 HAWTHORNE LN STE T1578
CHARLOTTE, NC 28204

Pharmacy Comments

Contract Details

Approval Date

10/4/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/22/2025
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

10/4/2022

340B Drug Pricing Program Database