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WALGREEN LOUISIANA CO., INC.
DSH190111 WILLIS KNIGHTON MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190111
Entity Address
2600 GREENWOOD ROAD
SHREVEPORT, LA 71103
Medicare Provider Number
190111
Participating Start Date
1/1/2007
Last Recertification Date
8/17/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 09998
3400 AIRLINE DR
BOSSIER CITY, LA 71111
Pharmacy Comments
Contract Details
Approval Date
4/8/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Jane Ward, Senior Vice President - CFO
(318) 212-4384
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/8/2019
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