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WALGREEN CO.
RRC440017-00 HOLSTON VALLEY HOSP & MED CTR
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Covered Entity Details
Entity Name
HOLSTON VALLEY HOSP & MED CTR
Subdivision Name
HOLSTON VALLEY HOSP & MED CTR
Type
Rural Referral Center
340B ID
RRC440017-00
Entity Address
130 W. RAVINE
KINGSPORT, TN 37662-0238
Medicare Provider Number
440017
Participating Start Date
7/1/2022
Last Recertification Date
9/4/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09459
6740 BRISTOL HWY
PINEY FLATS, TN 37686
Pharmacy Comments
Contract Details
Approval Date
7/20/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/20/2022
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