340B Drug Pricing Program Database
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WALGREEN CO.
RWI20825E Amity Medical Group
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Covered Entity Details
Entity Name
Amity Medical Group
Subdivision Name
Type
Ryan White Part A
340B ID
RWI20825E
Entity Address
7945 N Tryon
ste 112
Charlotte, NC 28262
Grant Number
H89HA11434
Participating Start Date
1/1/2024
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11251
2531 CUTHBERTSON RD.
WAXHAW, NC 28173
Pharmacy Comments
Contract Details
Approval Date
10/31/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Nestor Acevedo, Programs Manager
(704) 246-5131
Contract Pharmacy Representative
walgreens
pamela vlahopoulos, Senior Analyst, 340B Client Relationship
(847) 964-7780
Signed By Date
10/16/2023
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