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AVANT PHARMACY AND WELLNESS
RWI20825 Amity Medical Group, Inc
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Covered Entity Details
Entity Name
Amity Medical Group, Inc
Subdivision Name
AMG1 Harris Blvd location
Type
Ryan White Part A
340B ID
RWI20825
Entity Address
6010 EAST W T HARRIS BLVD
CHARLOTTE, NC 28215-4084
Grant Number
H89HA11434
Participating Start Date
10/1/2016
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
9/20/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
AHMED ELGOHARY, MANAGER
(704) 506-6974
Contract Pharmacy Representative
RX CLINIC PHARMACY
Amina Abubakar, CEO
(704) 537-0909
Signed By Date
9/20/2016
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