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NORTH CAROLINA CVS PHARMACY, L.L.C.
FQHCLA460E AMITY MEDICAL GROUP INC
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Covered Entity Details
Entity Name
AMITY MEDICAL GROUP INC
Subdivision Name
AMG - Randolph Rd
Type
Health Center Program Look-Alike
340B ID
FQHCLA460E
Entity Address
2300 Randolph Road
Charlotte, NC 28207-1127
Grant Number
LALCS48999
Participating Start Date
1/1/2025
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03852
3000 BATTLEGROUND AVE.
GREENSBORO, NC 27408
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
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
10/15/2024
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