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WILSON PHARMACY
RRC440012-00 BRISTOL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BRISTOL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC440012-00
Entity Address
1 MEDICAL PARK BLVD
BRISTOL, TN 37620
Medicare Provider Number
440012
Participating Start Date
7/1/2022
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WILSON PHARMACY
Pharmacy Address
350 BLOUNTVILLE HWY STE 102
BRISTOL, TN 37620
Pharmacy Comments
Contract Details
Approval Date
10/20/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
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
10/20/2022
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