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WALGREEN CO.
FQHCLA460B AMITY MEDICAL GROUP INC
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Covered Entity Details
Entity Name
AMITY MEDICAL GROUP INC
Subdivision Name
AMG3 Monroe Rd
Type
Health Center Program Look-Alike
340B ID
FQHCLA460B
Entity Address
9835 Monroe Rd Ste B
Charlotte, NC 28270-1471
Grant Number
LALCS48999
Participating Start Date
4/1/2024
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19943
2465 S NEW HOPE RD
GASTONIA, NC 28054
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2024
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