Contract Pharmacy Details

NORTH CAROLINA CVS PHARMACY, L.L.C.
FQHCLA460C AMITY MEDICAL GROUP INC

Covered Entity Details

Entity Name

AMITY MEDICAL GROUP INC

Subdivision Name

AMG4 Dallas

Type

Health Center Program Look-Alike

340B ID

FQHCLA460C

Entity Address

824 Lower Dallas Hwy
Dallas, NC 28034-9368

Grant Number

LALCS48999

Participating Start Date

4/1/2024

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

NORTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03526
306 EAST WOODLAWN RD
CHARLOTTE, NC 28217

Pharmacy Comments

Contract Details

Approval Date

4/14/2024

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

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/14/2024

340B Drug Pricing Program Database