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WILSON PHARMACY
DSH440050F Greeneville Community Hospital
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Covered Entity Details
Entity Name
Greeneville Community Hospital
Subdivision Name
BHMA Gastroenterology
Type
Disproportionate Share Hospital
340B ID
DSH440050F
Entity Address
1406 Tusculum Blvd
Ste 1200
Greeneville, TN 37745-4341
Medicare Provider Number
440050
Outpatient Facility Provider Number
Participating Start Date
10/1/2012
Last Recertification Date
8/30/2023
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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