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AVANT PHARMACY AND WELLNESS
RWI282050 Charlotte Health Initiative
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Covered Entity Details
Entity Name
Charlotte Health Initiative
Subdivision Name
Type
Ryan White Part A
340B ID
RWI282050
Entity Address
4115 The Plaza
Charlotte, NC 28205
Grant Number
H89HA11434
Participating Start Date
4/1/2018
Last Recertification Date
2/4/2023
Entity Termination Date
4/1/2024
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
4/10/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tagbo Ekwonu, President
(704) 307-8589
Contract Pharmacy Representative
RX CLINIC PHARMACY
Amina Abubakar, CEO
(704) 537-0909
Signed By Date
4/10/2018
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