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AVANT PHARMACY AND WELLNESS
RWI28215 EASTOWNE FAMILY PHYSICIANS, PA
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Covered Entity Details
Entity Name
EASTOWNE FAMILY PHYSICIANS, PA
Subdivision Name
Type
Ryan White Part A
340B ID
RWI28215
Entity Address
4115 The Plaza
CHARLOTTE, NC 28205
Grant Number
CHARLOTTE TGA
Participating Start Date
7/1/2010
Last Recertification Date
2/7/2018
Entity Termination Date
4/1/2019
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
7/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tagbo Ekwonu, Medical Director
(704) 532-4567
Contract Pharmacy Representative
RX CLINIC PHARMACY
Amina Abubakar, CEO
(704) 537-0909
Signed By Date
4/10/2018
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