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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06480
2800 W MALLARD CREEK CHURCH RD
CHARLOTTE, NC 28262
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2024
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