340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WILSON PHARMACY
RRC440017-06 HOLSTON VALLEY HOSP & MED CTR
Print
Covered Entity Details
Entity Name
HOLSTON VALLEY HOSP & MED CTR
Subdivision Name
Spine & Rehab
Type
Rural Referral Center
340B ID
RRC440017-06
Entity Address
Six Sheridan Square Suite 100
Kingsport, TN 37660
Medicare Provider Number
440017
Outpatient Facility Provider Number
Participating Start Date
4/1/2016
Last Recertification Date
8/18/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
WILSON PHARMACY
Pharmacy Address
DBA BALLAD HEALTH PHARMACY
1657 E STONE DR
STE A
KINGSPORT, TN 37660-4669
Pharmacy Comments
Contract Details
Approval Date
1/16/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
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
1/16/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session