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NORTH CAROLINA CVS PHARMACY, L.L.C.
RWI20825D Amity Medical Group
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Covered Entity Details
Entity Name
Amity Medical Group
Subdivision Name
Type
Ryan White Part A
340B ID
RWI20825D
Entity Address
2300A Randolph Rd 1586
Charlotte, NC 28207
Grant Number
H89HA11434
Participating Start Date
1/1/2024
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16235
9531 SOUTH BLVD
CHARLOTTE, NC 28273
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nestor Acevedo, Programs Manager
(704) 246-5131
Contract Pharmacy Representative
CVS
Courtney Wilson, Representative
(817) 201-1395
Signed By Date
1/15/2024
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