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Walmart Pharmacy 10-7611
RWI20825 Amity Medical Group, Inc
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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
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/15/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Olivia Bentley, Executive Director
(704) 968-8353
Contract Pharmacy Representative
CVS
Courtney Wilson, Representative
(817) 201-1395
Signed By Date
10/15/2023
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