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WILSON PHARMACY
DSH440050V Greeneville Community Hospital
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Covered Entity Details
Entity Name
Greeneville Community Hospital
Subdivision Name
BHMA OBGN and Womens Health
Type
Disproportionate Share Hospital
340B ID
DSH440050V
Entity Address
1424 Tusculum Blvd.
Suite 2800
Greeneville, TN 37745-4279
Medicare Provider Number
440050
Outpatient Facility Provider Number
Participating Start Date
4/1/2015
Last Recertification Date
8/31/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WILSON PHARMACY
Pharmacy Address
DBA BALLAD HEALTH PHARMACY
523 N STATE OF FRANKLIN RD
JOHNSON CITY, TN 37604
Pharmacy Comments
11/16/2012 address update (was 525 N. State of Franklin Rd.)
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Contract Pharmacy Representative
Balad Health
Steve Kilgore, SVP, Retail and Physician Services
(423) 915-5185
Signed By Date
1/15/2019
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