Contract Pharmacy Details

WALGREEN CO.
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

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #13980
130 W. RAVINE STE #101
KINGSPORT, TN 37660

Pharmacy Comments

Contract Details

Approval Date

1/18/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/18/2021

340B Drug Pricing Program Database