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RXCP4 INC DBA AVANT PHARMACY AND WELLNES
FQHCLA460A AMITY MEDICAL GROUP INC
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Covered Entity Details
Entity Name
AMITY MEDICAL GROUP INC
Subdivision Name
AMG2 Park Rd
Type
Health Center Program Look-Alike
340B ID
FQHCLA460A
Entity Address
10508 Park Rd Ste 130
Charlotte, NC 28210-8526
Grant Number
LALCS48999
Participating Start Date
4/1/2024
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
RXCP4 INC DBA AVANT PHARMACY AND WELLNES
Pharmacy Address
824 LOWER DALLAS HWY
DALLAS, NC 28034
Pharmacy Comments
Contract Details
Approval Date
4/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Olivia Bentley, Executive Director
(704) 968-8353
Contract Pharmacy Representative
Avant Pharmacy and Wellness
Amina Abubakar, CEO
(704) 537-0909
Signed By Date
4/10/2024
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