340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
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
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Jane Ward, Senior Vice President - CFO
(318) 212-4384
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/11/2024
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