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DSH190111CK WILLIS KNIGHTON MEDICAL CENTER, INC. (Active)
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Main Details
Name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Subdivision Name
HEM/ONC CLINIC - WKN Hematology Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190111CK
Medicare Provider Number
190111
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
8/7/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/6/2023
Last Recertification Date
8/17/2024
Contacts
Authorizing Official
Willis-Knighton Medical Center
Mary Jane Ward, Senior Vice President - CFO
(318) 212-4384
Primary Contact
Willis-Knighton Medical Center
TESSA ALBRITTON, DIV. DIRECTOR OF PHARMACY
(318) 212-4039
Addresses
Street Address
2600 Kings Hwy
300
Shreveport, LA 71103
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2018, terminated 4/1/2019. Reinstated 10/1/2023.
08/08/2023
April 2025
April 2025
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