Covered Entity Details

CH041279P Rural Health Services Consortium, Inc. (Active) - information as of 6/14/2025 10:09:54 AM

Main Details

Name

Rural Health Services Consortium, Inc.

Subdivision Name

Camp Creek Medical Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-021040

340B ID

CH041279P

Grant Number

H80CS00421

Additional Details

Current Program Status

Active

Registration Date

4/2/2018

Participating Start Date

7/1/2018

Participating Approval Date

4/5/2018

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Rural Health Services Consortium, Inc.
LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901

Primary Contact

Rural Health Services Consortium
Tara Worley, Pharmacist
(423) 921-1621

Addresses

Street Address

2994 Camp Creek Rd
Greeneville, TN 37743

Billing Address

Rural Health Services Consortium, Inc
4966 Highway 11 W
PO Box 850
Rogersville, TN 37857-6028

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
TN	Q032153,Q035718	1679672562,1568462372

Shipping Addresses

Shipping Address 1

RURAL HEALTH SERVICES CONSORTIUM
2994 Camp Creek Rd
Greeneville, TN 37743

Shipping Address 2

RURAL HEALTH SERVICES CONSORTIUM
4307 Highway 66 South
Rogersville, TN 37857

Shipping Address 3

RHSC Medical Complex at Kingsport Pharmacy (entity owned pharmacy)
1000 E Center Street
Kingsport, TN 37660

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10960	4325 HIGHWAY 66 S	ROGERSVILLE	TN	37857-3155	05/03/2023	05/04/2023			05/04/2023

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH0412790	Active	BPS-H80-004665	RURAL HEALTH SERVICES CONSORTIUM	HAWKINS MEDICAL CENTER	4966 HIGHWAY 11 WEST	ROGERSVILLE	TN
CH041279A	Active	BPS-H80-002977	RURAL HEALTH SERVICES CONSORTIUM	ROAN MOUNTAIN MEDICAL CENTER	152 HIGHWAY 143	ROAN MOUNTAIN	TN
CH041279B	Active	BPS-H80-004522	RURAL HEALTH SERVICES CONSORTIUM	BULLS GAP MEDICAL CENTER	260HWY 11-E	BULLS GAP	TN
CH041279C	Active	BPS-H80-004627	RURAL HEALTH SERVICES CONSORTIUM, INC.	BLUFF CITY MEDICAL CENTER	229 Highway 19 E	Bluff City	TN
CH041279D	Active	BPS-H80-009027	RURAL HEALTH SERVICES CONSORTIUM	SNEEDVILLE MEDICAL CENTER	1861 MAIN STREET	SNEEDVILLE	TN
CH041279E	Active	BPS-H80-002358	RURAL HEALTH SERVICES CONSORTIUM, INC.	BAILEYTON MEDICAL CENTER	580 Van Hill Rd	Greeneville	TN
CH041279H	Active	BPS-H80-002814	RURAL HEALTH SERVICES CONSORTIUM	MOUNTAIN CITY MEDICAL CENTER	222 OAK STREET	MOUNTAIN CITY	TN
CH041279I	Active	BPS-H80-003447	RURAL HEALTH SERVICES CONSORTIUM, INC.	DRY CREEK MEDICAL CENTER	1826 N Main Ave	Erwin	TN
CH041279J	Active	BPS-H80-000455	RURAL HEALTH SERVICES CONSORTIUM, INC.	KINGSPORT MEDICAL CENTER	737 E Sevier Ave	Kingsport	TN
CH041279K	Active	BPS-H80-000513	RURAL HEALTH SERVICES CONSORTIUM	LIMESTONE MEDICAL CENTER	105 LIMESTONE RURITAN RD.	LIMESTONE	TN
CH041279N	Active	BPS-H80-008682	RURAL HEALTH SERVICES CONSORTIUM, INC.	Rogersville Medical Complex	4307 Hwy 66S	Rogersville	TN
CH041279P	Active	BPS-H80-021040	Rural Health Services Consortium, Inc.	Camp Creek Medical Center	2994 Camp Creek Rd	Greeneville	TN
CH041279Q	Active	BPS-H80-017968	Rural Health Services Consortium, Inc.	Mobile Unit 2	4966 Highway 11w	Rogersville	TN
CH041279R	Active	BPS-H80-008658	Rural Health Services Consortium, Inc.	H.C. Mobile Unit #1	4966 Hwy 11 W	Rogersville	TN
CH041279S	Active	BPS-H80-035807	Rural Health Services Consortium, Inc.	RHSC Medical Center at Jonesborough	600 Boones Creek Rd	Jonesborough	TN
CH041279T	Active	BPS-H80-033837	RURAL HEALTH SERVICES CONSORTIUM, INC	RHSC Medical Complex at Kingsport	1000 E Center St	Kingsport	TN

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0412790	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2022
CH0412790	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2022
CH0412790	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2022
CH0412790	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2022
CH0412790	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/01/2022
CH0412790	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2022
CH0412790	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2022
CH0412790	ADAMS PHARMACY LLC	851 S SHADY ST		MOUNTAIN CITY	TN	37683	04/01/2020	12/01/2021
CH0412790	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	04/01/2016
CH0412790	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2019
CH0412790	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	10/01/2024
CH0412790	AMAZON PHARMACY #008	408 TECHNOLOGY PARKWAY	BUILDING B, STE 101	COLLEGE STATION	TX	77845	10/01/2024
CH0412790	AMAZON PHARMACY #009	7469 KINGSPOINTE PKWY STE 400		ORLANDO	FL	32819	10/01/2024
CH0412790	AMAZON PHARMACY #010	1331 E 6TH ST		CORONA	CA	92879	10/01/2024
CH0412790	APPALACHIAN SPECIALTY PHARMACY	932 HENDERSONVILLE RD STE 106		ASHEVILLE	NC	28803-6619	07/01/2020	05/21/2024
CH0412790	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	04/01/2016	09/24/2024
CH041279N	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	01/01/2018
CH0412790	AVELLA OF ORLANDO	100 TECHNOLOGY PARK STE 155		LAKE MARY	FL	32746-6205	04/01/2016	09/24/2024
CH0412790	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH0412790	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/01/2024
CH0412790	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/01/2024
CH0412790	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	04/01/2024
CH0412790	BISE PLLC	D/B/A SURGOINSVILLE PHARMACY	114 BELLAMY AVE	SURGOINSVILLE	TN	37873-2700	11/14/2014	05/21/2024
CH0412790	BULLS GAP DRUGS	412 HWY 11E		BULLS GAP	TN	37711	01/01/2013
CH041279B	BULLS GAP DRUGS	412 HWY 11E		BULLS GAP	TN	37711	09/08/2010
CH0412790	CHURCH HILL DRUG STORE	P.O. BOX 208	104 EAST MAIN STREET	CHURCH HILL	TN	37642	01/01/2021
CH0412790	CORLEY'S PHARMACY INC	1004 SNAPPS FERRY RD	PO BOX 874	GREENEVILLE	TN	37744-0874	01/01/2015	05/21/2024
CH041279E	CORLEY'S PHARMACY INC	1004 SNAPPS FERRY RD	PO BOX 874	GREENEVILLE	TN	37744-0874	10/06/2010
CH041279K	CORLEY'S PHARMACY INC	1004 SNAPPS FERRY RD	PO BOX 874	GREENEVILLE	TN	37744-0874	09/30/2010
CH0412790	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2022
CH0412790	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2022
CH0412790	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	01/01/2017	03/05/2020
CH0412790	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	04/01/2024
CH0412790	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2022
CH0412790	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2022
CH0412790	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2022
CH0412790	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2022
CH0412790	FOOD CITY PHARMACY #603	731 HIGHWAY 11 W		CHURCH HILL	TN	37642	01/01/2016
CH0412790	FOOD CITY PHARMACY #657	300 CLINCHFIELD STREET		KINGSPORT	TN	37660	10/15/2012
CH0412790	GENOA HEALTHCARE LLC	310 W 3RD NORTH ST	SUITE PHARM	MORRISTOWN	TN	37814	01/01/2024
CH0412790	GENOA HEALTHCARE LLC	205 W. SPRINGDALE AVE.		KNOXVILLE	TN	37917	01/01/2024
CH0412790	IC PHARMACY LLC	AMAZON PHARMACY #004	34 35TH STREET STE 4BSW, UNIT 28	BROOKLYN	NY	11232	10/01/2024
CH0412790	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2019
CH0412790	MED CENTER PHARMACY	900 WEST MAIN STREET	SUITE 2	ROGERSVILLE	TN	37857-3785	10/12/2012	06/28/2019
CH041279H	MOUNTAIN CITY PHARMACY	1641 S SHADY ST		MOUNTAIN CITY	TN	37683	09/30/2010
CH0412790	MOUNTAIN CITY PHARMACY	1641 S SHADY ST		MOUNTAIN CITY	TN	37683	04/12/2011
CH041279K	MOUNTAIN CITY PHARMACY	1641 S SHADY ST		MOUNTAIN CITY	TN	37683	05/04/2023
CH0412790	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05558	325 PINEOLA STREET/PO BOX 552	NEWLAND	NC	28657	10/01/2022
CH0412790	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	01/01/2024
CH0412790	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/01/2024
CH0412790	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025
CH0412790	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	10/01/2023
CH0412790	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/01/2023
CH0412790	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	01/01/2025
CH0412790	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
CH0412790	P&S PHARMACY INC	DBA U-SAVE DRUGS & HOSPICE	4017 HIGHWAY 66 S STE 7 HIGHWAY 66 SHOPPING CENTER	ROGERSVILLE	TN	37857-3196	09/08/2010
CH041279D	P&S PHARMACY INC	DBA U-SAVE DRUGS & HOSPICE	4017 HIGHWAY 66 S STE 7 HIGHWAY 66 SHOPPING CENTER	ROGERSVILLE	TN	37857-3196	01/01/2024
CH0412790	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	07/01/2018	08/14/2018
CH0412790	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2019
CH0412790	PILLPACK LLC	AMAZON PHARMACY #005	20416 72ND AVE S	KENT	WA	98032-2319	10/01/2024
CH0412790	PREMIER PHARMACY INC.	107 ESTATOA AVE	PO BOX 580	NEWLAND	NC	28657	04/01/2021
CH0412790	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/01/2024
CH0412790	RITE AID OF TENNESSEE, INC.	RITE AID #114	1252 NORTH MAIN STREET	ERWIN	TN	37650	09/07/2012	01/03/2018
CH0412790	RITE AID OF TENNESSEE, INC.	RITE AID #3344	1267 MAIN STREET P.O. BOX 95	SNEEDVILLE	TN	37869	09/07/2012	01/03/2018
CH0412790	RITE AID OF TENNESSEE, INC.	RITE AID #3418	1255 HIGHWAY 11 WEST	BEAN STATION	TN	37708	09/07/2012	01/03/2018
CH0412790	RITE AID OF TENNESSEE, INC.	RITE AID #1297	103 NORTH SHADY STREET	MOUNTAIN CITY	TN	37683	09/07/2012	01/03/2018
CH0412790	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/01/2024
CH0412790	ROAN MOUNTAIN PHARMACY	8251 HWY 19E		ROAN MOUNTAIN	TN	37687-3343	04/12/2011	08/12/2019
CH041279A	ROAN MOUNTAIN PHARMACY	8251 HWY 19E		ROAN MOUNTAIN	TN	37687-3343	10/27/2010	08/12/2019
CH0412790	ROAN MOUNTAIN PHARMACY	8251 HIGHWAY 19 E		ROAN MOUNTAIN	TN	37687	08/12/2019
CH041279A	ROAN MOUNTAIN PHARMACY	8251 HIGHWAY 19 E		ROAN MOUNTAIN	TN	37687	05/04/2023
CH0412790	ROLLER PHARMACY INC	109 N. MAIN AVE		ERWIN	TN	37650	10/12/2012
CH041279N	RURAL HEALTH SERVICES PHCY	4307 HIGHWAY 66 S		ROGERSVILLE	TN	37857	07/01/2014	11/09/2015
CH0412790	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	04/01/2024
CH041279D	SMITH-TURNER DRUG STORE INC	140 CHURCH ST		SNEEDVILLE	TN	37869	09/30/2010
CH0412790	SMITH-TURNER DRUG STORE INC	140 CHURCH ST		SNEEDVILLE	TN	37869	04/08/2011
CH041279R	SMITH-TURNER DRUG STORE INC	140 CHURCH ST		SNEEDVILLE	TN	37869	05/04/2023
CH041279E	SMITH-TURNER DRUG STORE INC	140 CHURCH ST		SNEEDVILLE	TN	37869	01/01/2024
CH0412790	SNAPPS FERRY PHARMACY, INC. DBA CORLEY'S	1004 SNAPPS FERRY RD		GREENEVILLE	TN	37745	04/01/2017
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07276	917 N. MAIN ST.	ERWIN	TN	37650	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07738	506 ASHEVILLE HWY	GREENEVILLE	TN	37743	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04240	4400 W. STONE DRIVE	KINGSPORT	TN	37660	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06357	1379 VOLUNTEER PKWY	BRISTOL	TN	37620	10/01/2022	06/13/2023
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07280	1100 WEST ELK AVE.	ELIZABETHTON	TN	37643	10/01/2022	11/07/2024
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	CVS PHARMACY # 17398	2626 E STONE DR SUITE 90	KINGSPORT	TN	37660	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07655	1161 US HWY 19 E	ELIZABETHTON	TN	37643	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03726	3030 WEST STATE STREET	BRISTOL	TN	37620	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07639	5215 MEMORIAL BLVD., SUITE 20	KINGSPORT	TN	37664	10/01/2022	02/22/2024
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04130	128 W. STONE DR.	KINGSPORT	TN	37660	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03489	5674 HWY 11-E SUITE F	PINEY FLATS	TN	37686	10/01/2022	07/01/2024
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07714	308 E. CEDAR ST	BRISTOL	TN	37620	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03792	420 PARK BLVD., #5	ROGERSVILLE	TN	37857	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03791	1510 E. ANDREW JOHNSON HWY.	GREENEVILLE	TN	37745	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07226	2114 E. ANDREW JOHNSON HWY.	MORRISTOWN	TN	37814	10/01/2022
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05664	4106 FT. HENRY DR.	KINGSPORT	TN	37663	10/01/2022
CH041279B	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03489	5674 HWY 11-E SUITE F	PINEY FLATS	TN	37686	05/04/2023
CH041279I	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03792	420 PARK BLVD., #5	ROGERSVILLE	TN	37857	05/04/2023
CH041279B	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03792	420 PARK BLVD., #5	ROGERSVILLE	TN	37857	01/01/2024
CH041279S	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04130	128 W. STONE DR.	KINGSPORT	TN	37660	04/01/2024
CH0412790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07235	4209 N ROAN ST.,	JOHNSON CITY	TN	37601	10/01/2024
CH0412790	VALUE RX SNEEDVILLE LLC. #4	1400 MAIN ST.		SNEEDVILLE	TN	37869	07/01/2017
CH041279J	VALUE RX SNEEDVILLE LLC. #4	1400 MAIN ST.		SNEEDVILLE	TN	37869	05/04/2023
CH0412790	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2018
CH0412790	WAL-MART PHARMACY 10-0599	3200 FORT HENRY DR		KINGSPORT	TN	37664	10/01/2018
CH041279Q	WAL-MART PHARMACY 10-0599	3200 FORT HENRY DR		KINGSPORT	TN	37664	05/04/2023
CH0412790	WAL-MART PHARMACY 10-0620	220 CENTURY BLVD		BRISTOL	TN	37620	04/01/2013
CH0412790	WAL-MART PHARMACY 10-0680	3755 E. ANDREW JOHNSON HWY		GREENVILLE	TN	37745	04/01/2013
CH0412790	WAL-MART PHARMACY 10-0685	475 SO. DAVY CROCKETT PKWY.		MORRISTOWN	TN	37813	10/01/2018
CH0412790	WAL-MART PHARMACY 10-0690	1001 OVER MOUNTAIN AVENUE		ELIZABETHTON	TN	37643	04/01/2013
CH0412790	WAL-MART PHARMACY 10-0742	2500 WEST STONE DRIVE		KINGSPORT	TN	37660	10/01/2018
CH0412790	WAL-MART PHARMACY 10-3234	4331 HIGHWAY 66		ROGERSVILLE	TN	37857	09/21/2012
CH041279A	WAL-MART PHARMACY 10-3234	4331 HIGHWAY 66		ROGERSVILLE	TN	37857	01/01/2024
CH0412790	WAL-MART PHARMACY 10-3852	110 ROCKY BOTTOM RD.		UNICOI	TN	37692	10/01/2018
CH0412790	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2018
CH0412790	WALGREEN CO.	DBA: WALGREENS # 04330	121 N. NORTHSHORE DRIVE	KNOXVILLE	TN	37919	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 05347	2412 W. STATE STREET	BRISTOL	TN	37620	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 05597	2200 MEMORIAL BLVD.	KINGSPORT	TN	37664	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 05828	1420 W STONE DR	KINGSPORT	TN	37660	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 06256	1430 S ROAN ST	JOHNSON CITY	TN	37601	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 06788	1959 W ANDREW JOHNSON HWY	MORRISTOWN	TN	37814	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 07049	1650 E ANDREW JOHNSON HWY	GREENEVILLE	TN	37745-4274	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 07285	2240 N ROAN STREET	JOHNSON CITY	TN	37601-2521	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 09046	1560 LEE HWY	BRISTOL	VA	24201	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 09306	3900 FORT HENRY DRIVE	COLONIAL HEIGHTS	TN	37663-2026	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 09428	4500 W STONE DRIVE	KINGSPORT	TN	37660	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 09429	214 BROAD ST	ELIZABETHTON	TN	37643-2714	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 09459	6740 BRISTOL HWY	PINEY FLATS	TN	37686	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #10192	1388 VOLUNTEER PKWY.	BRISTOL	TN	37620-5700	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 10299	401 N MAIN AVE	ERWIN	TN	37650-1207	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS # 10330	2340 HWY 394	BLOUNTVILLE	TN	37617	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #10918	4210 N. ROAN ST.	JOHNSON CITY	TN	37601-1130	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #10960	4325 HIGHWAY 66 S	ROGERSVILLE	TN	37857-3155	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #11113	5104 BOBBY HICKS HWY.	GRAY	TN	37615-6217	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #11813	251 S CUMBERLAND ST	MORRISTOWN	TN	37813	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #11907	104 ASHEVILLE HWY.	GREENEVILLE	TN	37743-4602	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #12373	606 N. BROADWAY ST.	JOHNSON CITY	TN	37601-3535	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #12858	2103 E. ANDREW JOHNSON HWY.	MORRISTOWN	TN	37814-5411	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #12934	2790 E. STONE DR.	KINGSPORT	TN	37660	04/01/2013
CH0412790	WALGREEN CO.	DBA: WALGREENS #13891	429 N. STATE OF FRANKLIN RD.	JOHNSON CITY	TN	37604	04/01/2013
CH0412790	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13980	130 W. RAVINE STE #101	KINGSPORT	TN	37660	04/01/2013
CH0412790	WALGREEN CO.	WALGREENS #18327	103 NORTH SHADY STREET	MOUNTAIN CITY	TN	37683	01/04/2018
CH0412790	WALGREEN CO.	DBA: WALGREENS #17991	1267 MAIN STREET P.O. BOX 95	SNEEDVILLE	TN	37869	01/04/2018	11/07/2022
CH0412790	WALGREEN CO.	DBA: WALGREENS #17569	1149 HIGHWAY 11W	BEAN STATION	TN	37708	01/04/2018
CH0412790	WALGREEN CO.	RITE AID #00114	1252 NORTH MAIN STREET	ERWIN	TN	37650	01/04/2018	08/09/2018
CH0412790	WALGREEN CO.	DBA: WALGREENS #13660	531 E. JACKSON BLVD.	JONESBOROUGH	TN	37659	04/01/2021
CH041279H	WALGREEN CO.	DBA: WALGREENS # 07049	1650 E ANDREW JOHNSON HWY	GREENEVILLE	TN	37745-4274	05/04/2023
CH041279C	WALGREEN CO.	DBA: WALGREENS # 09459	6740 BRISTOL HWY	PINEY FLATS	TN	37686	07/01/2023	05/08/2023
CH041279P	WALGREEN CO.	DBA: WALGREENS #10960	4325 HIGHWAY 66 S	ROGERSVILLE	TN	37857-3155	05/04/2023
CH041279D	WALGREEN CO.	DBA: WALGREENS # 10330	2340 HWY 394	BLOUNTVILLE	TN	37617	07/01/2023	05/04/2023
CH041279E	WALGREEN CO.	DBA: WALGREENS # 05828	1420 W STONE DR	KINGSPORT	TN	37660	05/04/2023
CH041279D	WALGREEN CO.	DBA: WALGREENS # 10330	2340 HWY 394	BLOUNTVILLE	TN	37617	05/04/2023
CH041279C	WALGREEN CO.	DBA: WALGREENS # 09459	6740 BRISTOL HWY	PINEY FLATS	TN	37686	05/09/2023
CH041279C	WALGREEN CO.	DBA: WALGREENS #10960	4325 HIGHWAY 66 S	ROGERSVILLE	TN	37857-3155	01/01/2024
CH041279R	WALGREEN CO.	DBA: WALGREENS #17569	1149 HIGHWAY 11W	BEAN STATION	TN	37708	04/01/2024
CH041279C	WALGREEN CO.	DBA: WALGREENS # 09429	214 BROAD ST	ELIZABETHTON	TN	37643-2714	04/01/2024
CH041279K	WALGREEN CO.	WALGREENS #18327	103 NORTH SHADY STREET	MOUNTAIN CITY	TN	37683	04/01/2024
CH041279B	WALGREEN CO.	DBA: WALGREENS # 05828	1420 W STONE DR	KINGSPORT	TN	37660	04/01/2024
CH0412790	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2013	07/07/2015
CH0412790	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Delete	Recertification	RHSC Medical Complex at Kingpsort Pharmacy (entity owned pharmacy) 1000 E Center Street Kingsport, TN 37660		2/11/2025 6:44 AM
Addresses	Shipping Address	Insert	Recertification		RHSC Medical Complex at Kingsport Pharmacy (entity owned pharmacy) 1000 E Center Street Kingsport, TN 37660	2/11/2025 6:44 AM
Details	Last Recertification Date	Update	Recertification	2/6/2024 3:21:12 PM	2/11/2025 6:44:15 AM	2/11/2025 6:44 AM
Addresses	Shipping Address	Insert	Group Change Request		RHSC Medical Complex at Kingpsort Pharmacy (entity owned pharmacy) 1000 E Center Street Kingsport, TN 37660	10/2/2024 10:22 AM
Contacts	Primary Contact	Update	Profile Change Request	Worley, Tara Pharmacist Rural Health Services Consortium 4239211650	Worley, Tara Pharmacist Rural Health Services Consortium 4239211621	7/2/2024 9:37 AM
Addresses	Billing Address	Update	Change Request	Rural Health Services Consortium, Inc 4307 Highway 66 South PO Box 850 Rogersville, TN 37857	Rural Health Services Consortium, Inc 4966 Highway 11 W PO Box 850 Rogersville, TN 37857-6028	5/22/2024 9:55 AM
Details	Last Recertification Date	Update	Recertification	2/15/2023 4:43:31 PM	2/6/2024 3:21:12 PM	2/6/2024 3:21 PM
Details	Last Recertification Date	Update	Recertification	2/8/2022 4:15:24 PM	2/15/2023 4:43:31 PM	2/15/2023 4:43 PM
Details	Last Recertification Date	Update	Recertification	2/3/2021 12:53:51 PM	2/8/2022 4:15:24 PM	2/8/2022 4:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1679672562	2/3/2021 12:53 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	2/3/2021 12:53 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568462372	2/3/2021 12:53 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	2/3/2021 12:53 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679672562 ( )		2/3/2021 12:53 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1568462372 ( )		2/3/2021 12:53 PM
Details	Last Recertification Date	Update	Recertification	2/5/2020 12:23:40 PM	2/3/2021 12:53:51 PM	2/3/2021 12:53 PM
Details	Last Recertification Date	Update	Recertification	1/30/2019 12:18:07 PM	2/5/2020 12:23:40 PM	2/5/2020 12:23 PM
Details	Last Recertification Date	Update	Recertification		1/30/2019 12:18:07 PM	1/30/2019 12:18 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/15/2019 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q032153	1/15/2019 12:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	1/15/2019 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/15/2019 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q035718	1/15/2019 12:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	1/15/2019 12:21 PM
Addresses	Shipping Address	Insert	Change Request		RURAL HEALTH SERVICES CONSORTIUM 2994 Camp Creek Rd Greeneville, TN 37743	8/15/2018 3:20 PM
Addresses	Shipping Address	Insert	Change Request		RURAL HEALTH SERVICES CONSORTIUM 4307 Highway 66 South Rogersville, TN 37857	8/15/2018 3:20 PM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		BUCK, LINDA W. CHIEF EXECUTIVE OFFICER Rural Health Services Consortium, Inc. 4232729163-8901	4/5/2018 10:36 AM
Details	340B ID	Update	New Registration		CH041279P	4/5/2018 10:36 AM
Dates	Participating Approval Date	Update	New Registration		4/5/2018 10:36:10 AM	4/5/2018 10:36 AM
Details	State	Update	New Registration	Pending	Approved	4/5/2018 10:36 AM
Dates	Signed By Date	Update	New Registration		4/4/2018 4:17:43 PM	4/5/2018 10:36 AM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	4/5/2018 10:36 AM
Addresses	Main Address	Insert	New Registration		2994 Camp Creek Rd Greeneville, TN 37743	4/2/2018 8:47 AM
Addresses	Billing Address	Insert	New Registration		Rural Health Services Consortium, Inc 4307 Highway 66 South PO Box 850 Rogersville, TN 37857	4/2/2018 8:47 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1679672562	4/2/2018 8:47 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1568462372	4/2/2018 8:47 AM
Contacts	Primary Contact	Insert	New Registration		Worley, Tara Pharmacist Rural Health Services Consortium 4239211650	4/2/2018 8:47 AM
Contacts	Authorizing Official	Insert	New Registration		BUCK, LINDA W. CHIEF EXECUTIVE OFFICER Rural Health Services Consortium, Inc. 4232729163-8901	4/2/2018 8:47 AM
Details	Last Recertification Date	Insert	New Registration			4/2/2018 8:47 AM
Details	Grant Number	Insert	New Registration		H80CS00421	4/2/2018 8:47 AM
Details	340B ID	Insert	New Registration			4/2/2018 8:47 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2018 8:47 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2018 8:47 AM
Details	Medicare Provider Number	Insert	New Registration			4/2/2018 8:47 AM
Details	Entity Name	Insert	New Registration		Rural Health Services Consortium, Inc.	4/2/2018 8:47 AM
Details	Program Code	Insert	New Registration		CH	4/2/2018 8:47 AM
Details	Entity Subname	Insert	New Registration		Camp Creek Medical Center	4/2/2018 8:47 AM
Dates	Participating Approval Date	Insert	New Registration			4/2/2018 8:47 AM
Details	State	Insert	New Registration		Pending	4/2/2018 8:47 AM
Dates	Registration Date	Insert	New Registration		4/2/2018 8:47:44 AM	4/2/2018 8:47 AM
Dates	Signed By Date	Insert	New Registration			4/2/2018 8:47 AM
Dates	Start Date	Insert	New Registration			4/2/2018 8:47 AM
Terminations	Termination Comments	Insert	New Registration			4/2/2018 8:47 AM
Terminations	Termination Date	Insert	New Registration			4/2/2018 8:47 AM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2018 8:47 AM
Terminations	Termination Reason	Insert	New Registration			4/2/2018 8:47 AM

340B Drug Pricing Program Database