Contract Pharmacy Details

WALGREEN LOUISIANA CO., INC.
DSH190111 WILLIS KNIGHTON MEDICAL CENTER, INC.

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 # 04998
9209 MANSFIELD RD.
SHREVEPORT, LA 71118

Pharmacy Comments

Contract Details

Approval Date

1/14/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Charles D. Daigle, COO
(318) 212-4292

Contract Pharmacy Representative

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

Signed By Date

1/14/2014

340B Drug Pricing Program Database