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AVANT PHARMACY AND WELLNESS
RWI28206 Progressive Recovery Outreach Inc.
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Covered Entity Details
Entity Name
Progressive Recovery Outreach Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI28206
Entity Address
3129 creighton dr
CHARLOTTE, NC 28205-6209
Grant Number
H89HA11434
Participating Start Date
4/1/2015
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
AVANT PHARMACY AND WELLNESS
Pharmacy Address
6010 E WT HARRIS BLVD
CHARLOTTE, NC 28215-4084
Pharmacy Comments
Contract Details
Approval Date
10/5/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ameer Green, Executive Director
(704) 891-6404
Contract Pharmacy Representative
RX CLINIC PHARMACY
Amina Abubakar, CEO
(704) 537-0909
Signed By Date
10/5/2016
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