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PROCARE PHARMACY, L.L.C.
RWI20825E Amity Medical Group
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Covered Entity Details
Entity Name
Amity Medical Group
Subdivision Name
Type
Ryan White Part A
340B ID
RWI20825E
Entity Address
7945 N Tryon
ste 112
Charlotte, NC 28262
Grant Number
H89HA11434
Participating Start Date
1/1/2024
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
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
10/14/2024
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