Contract Pharmacy Details

PRINCETON DRUG
DSH440063 JOHNSON CITY MEDICAL CENTER

Covered Entity Details

Entity Name

JOHNSON CITY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH440063

Entity Address

400 N. STATE OF FRANKLIN RD.
JOHNSON CITY, TN 37604-6094

Medicare Provider Number

440063

Participating Start Date

7/1/2005

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

PRINCETON DRUG

Pharmacy Address

MARK REED
105 BROYLES DRIVE
JOHNSON CITY, TN 37601-3760

Pharmacy Comments

Contract Details

Approval Date

10/23/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Shane Hilton, VP/CFO - Market Operations
(423) 302-3467

Contract Pharmacy Representative

R&J Drug Company
Julie Kirkham, Owner/President
(423) 926-9137

Signed By Date

10/23/2018

340B Drug Pricing Program Database