340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
FQHCLA460 AMITY MEDICAL GROUP INC
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Covered Entity Details
Entity Name
AMITY MEDICAL GROUP INC
Subdivision Name
AMG1 Harris Blvd
Type
Health Center Program Look-Alike
340B ID
FQHCLA460
Entity Address
6010 E W T Harris Blvd Ste A
Charlotte, NC 28215-4084
Grant Number
LALCS48999
Participating Start Date
4/1/2024
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
7/5/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Olivia Bentley, Executive Director
(704) 968-8353
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/5/2024
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