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NORTH CAROLINA CVS PHARMACY, L.L.C.
FQHCLA460D AMITY MEDICAL GROUP INC
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Covered Entity Details
Entity Name
AMITY MEDICAL GROUP INC
Subdivision Name
AMG - N Tryon Rd
Type
Health Center Program Look-Alike
340B ID
FQHCLA460D
Entity Address
7945 N. Tryon St # 112
Charlotte, NC 28262-3587
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 # 04202
1830 WEST DIXON BOULEVARD
SHELBY, NC 28152
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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