Covered Entity Details

DSH450124 Dell Seton Medical Center at The University of Texas (Active) - information as of 6/28/2025 12:15:49 AM

Main Details

Name

Dell Seton Medical Center at The University of Texas

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450124

Medicare Provider Number

450124

Additional Details

Current Program Status

Active

Registration Date

1/5/2021

Participating Start Date

3/11/2021

Participating Approval Date

3/9/2021

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Dell Seton Medical Center at The University of Texas
Laura Fohn, Chief Operating Officer
(512) 324-7168

Primary Contact

Ascension Health
Rodrigo Rodriguez, 340B Program Director
(512) 324-9999 Ext: 77031

Addresses

Street Address

1500 RED RIVER ST
AUSTIN, TX 78701

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participated starting 1/1/2000; Terminated 1/1/2020; Reinstated 4/1/2021.	03/08/2021
8/16/10 SUB-DIV NAME ADDED	08/16/2010

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
TX	251047,137265806	1093810327,1124386354

Shipping Addresses

Shipping Address 1

Outpatient Pharmacy
1500 Red River St
14052
Austin, TX 78701

Shipping Address 2

Dell Seton Medical Center Pharmacy
1500 Red River St
Austin, TX 78701

Shipping Address 3

Dell Seton Medical Center RX1001
7701 Metropolis Drive
200C
Austin, TX 78744

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	9307 KIRBY DR		HOUSTON	TX	77054-2516	07/10/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	4343 W ROYAL LN STE 124		IRVING	TX	75063-2299	07/10/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/03/2018	10/01/2018	10/01/2018	07/10/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	AFFILIATED HEALTH SERVICES, INC.	DBA ASCENSION RX 1303	30055 NORTHWESTERN HWY STE 225	FARMINGTON HILLS	MI	48334	10/08/2021	01/01/2022	01/14/2022	01/18/2022
Contract Detail	ASCENSION PHARMACY SERVICES, LLC	DBA ASCENSION RX 1303	30055 NORTHWESTERN HWY STE 225	FARMINGTON HILLS	MI	48334	01/14/2022	04/01/2022		04/01/2022
Contract Detail	ASCENSION RX 1001	ASCENSION PHARMACY SERVICES, LLC.	7701 METROPOLIS DR STE 200B	AUSTIN	TX	78744-3125	07/19/2021	10/01/2021		10/01/2021
Contract Detail	ASCENSION RX 3001	7701 METROPOLIS DR STE 200C		AUSTIN	TX	78744-3125	07/19/2021	10/01/2021	08/01/2022	09/09/2022
Contract Detail	ASCENSION SETON CENTRAL OUTPATIENT PHARM	1500 RED RIVER ST	SUITE 14052	AUSTIN	TX	78701	08/03/2012	08/03/2012	01/01/2020	01/01/2020
Contract Detail	ASCENSION SETON CENTRAL OUTPATIENT PHARM	1500 RED RIVER ST	SUITE 14052	AUSTIN	TX	78701	04/05/2021	07/01/2021		07/01/2021
Contract Detail	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	H-E-B, LP	H-E-B PHARMACY WAREHOUSE	6520 FRATT RD	SAN ANTONIO	TX	78218	10/04/2018	01/01/2019	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #014	5401 SOUTH FM 1626		KYLE	TX	78640	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #024	11521 NORTH FM620, BLDG A		AUSTIN	TX	78726	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #029	701 CAPITAL OF TEXAS HWY , BUILDING C		WEST LAKE HILLS	TX	78746	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #031	12860 N. HIGHWAY 183		AUSTIN	TX	78750	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #034	3750 GATTIS SCHOOL RD.		ROUND ROCK	TX	78664	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #068	5800 W. SLAUGHTER LANE		AUSTIN	TX	78749	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #091	2508 E RIVERSIDE DRIVE		AUSTIN	TX	78741	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #096	7025 VILLAGE CENTER DRIVE		AUSTIN	TX	78731	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #161	7112 ED BLUESTEIN		AUSTIN	TX	78723	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #183	9414 N. LAMAR		AUSTIN	TX	78753	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #202	5808 BURNET RD		AUSTIN	TX	78756	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #218	12407 N. MOPAC EXPRESSWAY		AUSTIN	TX	78758	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #227	2110 NEW SLAUGHTER LANE		AUSTIN	TX	78748	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #229	6607 IH-35 SOUTH		AUSTIN	TX	78744	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #236	1434 WELLS BRANCH PKWY		PFLUGERVILLE	TX	78660	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #243	641 E. HOPKINS		SAN MARCOS	TX	78666	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #265	170 E. WHITESTONE		CEDAR PARK	TX	78613	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #269	10710 RESEARCH BLVD, STE 200		AUSTIN	TX	78759	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #373	16900 N. FM 620		ROUND ROCK	TX	78681	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #388	6001 WEST PARMER LN		AUSTIN	TX	78727	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #404	12400 STATE HWY 71 WEST SUITE 100		BEE CAVE	TX	78738	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #416	450 EAST TRAVIS		LA GRANGE	TX	78945	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #425	1000 E. 41ST STREET		AUSTIN	TX	78751	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #428	6900 BRODIE LN		AUSTIN	TX	78745	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #433	105 S. BOUNDARY		BURNET	TX	78611	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #445	403 S COLORADO ST		LOCKHART	TX	78644	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #451	7301 N. FM 620		AUSTIN	TX	78726	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #455	200 W. HOPKINS		SAN MARCOS	TX	78666	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #465	2701 E 7TH ST		AUSTIN	TX	78702	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #475	1080 W. HWY 290		ELGIN	TX	78621	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #476	500 CANYON RIDGE DRIVE		AUSTIN	TX	78753	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #477	15300 S IH-35		BUDA	TX	78610	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #479	201 N FM 685		PFLUGERVILLE	TX	78660	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #487	4500 FM 2338		GEORGETOWN	TX	78628	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #580	2800 E WHITESTONE		CEDAR PARK	TX	78613	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #582	104 HASLER BLVD.		BASTROP	TX	78602	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #591	1700 EAST PALM VALLEY BLVD		ROUND ROCK	TX	78664	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #592	651 NORTH US HIGHWAY 183		LEANDER	TX	78641	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #611	598 E. HWY 290		DRIPPING SPRINGS	TX	78620	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #639	1801 EAST 51ST STREET		AUSTIN	TX	78723	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #659	14028 NORTH US 183		AUSTIN	TX	78717	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #673	250 UNIVERSITY BLVD.		ROUND ROCK	TX	78665	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #696	5000 GATTIS SCHOOL RD		HUTTO	TX	78634	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #714	2000 RANCH RD 620 S	STE A	LAKEWAY	TX	78734	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #735	1503 HWY 1431 WEST		MARBLE FALLS	TX	78654	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #754	2400 S CONGRESS AVE		AUSTIN	TX	78704	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #765	7901 W US 290 HWY		AUSTIN	TX	78736	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	HEB PHARMACY #781	1010 W. UNIVERSITY AVE		GEORGETOWN	TX	78628	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	INFUSION PARTNERS, LLC	DBA BIOSCRIP INFUSION SERVICES	5446 HIGHWAY 290 WEST SUITE 203	AUSTIN	TX	78735-8830	07/16/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	MAXOR SPECIALTY PHARMACY	102 SW 3RD AVE		AMARILLO	TX	79101-1443	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	MAXOR SPECIALTY PHARMACY	6101 43RD ST, STE C		LUBBOCK	TX	79407	07/17/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	10/07/2019	01/01/2020	01/01/2020	01/01/2020
Contract Detail	OPTUM PHARMACY 800, INC.	3016 GUADALUPE ST STE A		AUSTIN	TX	78705-2861	07/30/2015	10/01/2015	01/01/2020	01/01/2020
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	SENDERRA RX PHARMACY	SENDERRA RX PARTNERS, LLC	3712 E PLANO PKWY STE 200	PLANO	TX	75074	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	SPECIALTY THERAPEUTIC CARE	1311 W SAM HOUSTON PKWY N STE 150		HOUSTON	TX	77043-4015	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	WAL-MART PHARMACY 10-0077	3701 NORTH MAIN STREET		TAYLOR	TX	76574	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0280	709 WEST HWY 79		ROCKDALE	TX	76567	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0290	1114 EAST SARAH DEWITT DR.		GONZALES	TX	78629	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0292	1904 S COLORADO ST.		LOCKHART	TX	78644	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0293	1712 E. WASHINGTON		NAVASOTA	TX	77868	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0404	1015 HIGHWAY 80		SAN MARCOS	TX	78666	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0473	US HWY 290/2374 E. AUSTIN		GIDDINGS	TX	78942	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0475	2701 SOUTH I.H. 35		ROUND ROCK	TX	78664	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0503	PO BOX 388	2103 MILAM ST	COLUMBUS	TX	78934	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0781	2700 US HWY 281 NORTH		MARBLE FALLS	TX	78654	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0846	1915 WEST STATE HIGHWAY 71		LA GRANGE	TX	78945	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0865	1209 I H-35 SOUTH		NEW BRAUNFELS	TX	78130	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-0901	550 S. 123 BYPASS		SEGUIN	TX	78155	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-1042	488 HIGHWAY 71 WEST		BASTROP	TX	78602	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-1073	1710 CENTRAL TEXAS EXPRESSWAY		LAMPASAS	TX	76550	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-1129	13201 FM 620 ROAD NORTH		AUSTIN (NW)	TX	78729	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-1185	1030 NORWOOD PARK BLVD		AUSTIN	TX	78753	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-1253	710 EAST BEN WHITE BLVD		AUSTIN	TX	78704	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-1303	620 S INTERSTATE 35		GEORGETOWN	TX	78628	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-2133	5017 U.S. HIGHWAY 290 WEST		AUSTIN (MID W)	TX	78735	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-2991	201 WALTON WAY		CEDAR PARK	TX	78613	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-3569	12900 N I-35 SERVICE RD SB		AUSTIN (NW)	TX	78753	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-4219	690 OLD SAN ANTONIO ROAD		BUDA	TX	78610	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-4554	2525 W ANDERSON LN.		AUSTIN	TX	78757	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	WAL-MART PHARMACY 10-5317	9300 SOUTH IH-35 BLDG. "B"		AUSTIN	TX	78748	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-5479	1548 FM 685		PFLUGERVILLE	TX	78660	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-5480	4700 EAST PALM VALLEY BLVD		ROUND ROCK (NE)	TX	78664	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/03/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01933	2501 S LAMAR BLVD	AUSTIN	TX	78704-4730	10/22/2012	10/22/2012	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03159	2021 W PECAN ST	PFLUGERVILLE	TX	78660	10/22/2012	10/22/2012	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04550	639 E. HOPKINS ST.	SAN MARCOS	TX	78666	10/22/2012	10/22/2012	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06861	9307 N LAMAR BLVD	AUSTIN	TX	78753	10/22/2012	10/22/2012	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09810	1357 EAST COURT STREET	SEGUIN	TX	78155-5130	10/22/2012	10/22/2012	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10841	1660 MAIN ST.	BUDA	TX	78610	10/22/2012	10/22/2012	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11131	200 S. COLORADO ST.	LOCKHART	TX	78644-2733	10/22/2012	10/22/2012	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16468	3701 GUADALUPE ST STE 102	AUSTIN	TX	78705	07/14/2017	10/01/2017	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10615	5345 N INTERSTATE 35	AUSTIN	TX	78723	07/14/2017	10/01/2017	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02462	1144 AIRPORT BLVD	AUSTIN	TX	78702	07/05/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/05/2013	07/01/2013	07/27/2015	05/24/2017
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/05/2013	07/01/2013	07/27/2015	05/24/2017
Contract Detail	WALMART PHARMACY # 10-3169	11923 US HWY 290 E		MANOR	TX	78653	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WALMART PHARMACY # 10-3170	1320 W. HWY 290		ELGIN	TX	78621	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WALMART PHARMACY 10-4130	5754 KYLE PARKWAY		KYLE	TX	78640	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WALMART PHARMACY 10-4163	2801 EAST WHITESTONE BLVD		CEDAR PARK	TX	78613	07/03/2018	10/01/2018	07/31/2019	08/08/2019
Contract Detail	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	10/15/2014	01/01/2015	09/30/2018	09/10/2019

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH450124A	Child	DSH	Ascension Seton d/b/a Dell Seton Medical Center at The University of Texas	Seton Infusion Center, a Department of Dell Seton Medical Center at The University of Texas	University of Texas at Austin Health Transformation Building	Austin	TX	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Change Request	450124 (TX)		2/4/2025 2:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/4/2025 2:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		251047	2/4/2025 2:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	2/4/2025 2:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1124386354	2/4/2025 2:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	2/4/2025 2:46 PM
Addresses	Shipping Address	Insert	Change Request		Outpatient Pharmacy 1500 Red River St 14052 Austin, TX 78701	9/24/2024 6:11 AM
Addresses	Shipping Address	Insert	Change Request		Dell Seton Medical Center Pharmacy 1500 Red River St Austin, TX 78701	9/24/2024 6:11 AM
Addresses	Shipping Address	Insert	Change Request		Dell Seton Medical Center RX1001 7701 Metropolis Drive 200C Austin, TX 78744	9/24/2024 6:11 AM
Details	Last Recertification Date	Update	Recertification	9/25/2023 11:30:14 AM	8/28/2024 12:14:59 PM	8/28/2024 12:14 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 7:07:56 AM	9/25/2023 11:30:14 AM	9/25/2023 11:30 AM
Contacts	Authorizing Official	Update	Change Request	Hatton, Tad Allen VP/COO Dell Seton Medical Center 5124843507	Fohn, Laura Chief Operating Officer Dell Seton Medical Center at The University of Texas 5123247168	12/8/2022 7:06 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	137265083 (TX)		8/25/2022 7:07 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801950670 (TX)		8/25/2022 7:07 AM
Details	Last Recertification Date	Update	Recertification	8/27/2021 8:42:08 AM	8/25/2022 7:07:56 AM	8/25/2022 7:07 AM
Contacts	Authorizing Official	Update	Profile Change Request	Hatton, Tad Allen VP/COO Seton Medical Center Austin 5124843507	Hatton, Tad Allen VP/COO Dell Seton Medical Center 5124843507	6/13/2022 12:56 PM
Contacts	Authorizing Official	Update	Change Request	Brierty, Timothy COO Dell Seton Medical Center at The University of Texas 5123247006	Hatton, Tad Allen VP/COO Seton Medical Center Austin 5124843507	6/13/2022 11:23 AM
Details	Last Recertification Date	Update	Recertification		8/27/2021 8:42:08 AM	8/27/2021 8:42 AM
Details	Entity Name	Update	Change Request	DELL SETON MEDICAL CENTER AT THE UNI	Dell Seton Medical Center at The University of Texas	3/29/2021 6:37 AM
Details	State	Update	OPA Edit	Approved	Active	3/11/2021 2:49 PM
Dates	Start Date	Update	OPA Edit	4/1/2021 12:00:00 AM	3/11/2021 12:00:00 AM	3/11/2021 2:49 PM
Addresses	Main Address	Update	Reinstatement	1500 Red River Street AUSTIN, TX 78701	1500 RED RIVER ST AUSTIN, TX 78701	3/9/2021 8:02 AM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1801950670 ( )		3/9/2021 8:02 AM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1093810327	3/9/2021 8:02 AM
Medicaid Billing	NPI: State	Insert	Reinstatement		TX	3/9/2021 8:02 AM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1801950670	3/9/2021 8:02 AM
Medicaid Billing	NPI: State	Insert	Reinstatement		TX	3/9/2021 8:02 AM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1093810327 ( )		3/9/2021 8:02 AM
Contacts	Primary Contact	Update	Reinstatement	Aziz, Shewan M Senior Director of Pharmacy Seton Healthcare Family 5123247303	Rodriguez, Rodrigo 340B Program Director Ascension Health 5123249999-77031	3/9/2021 8:02 AM
Contacts	Signed By	Insert	Reinstatement		Brierty, Timothy COO Dell Seton Medical Center at The University of Texas 5123247006	3/9/2021 8:02 AM
Details	Last Recertification Date	Update	Reinstatement	9/9/2019 8:38:56 AM		3/9/2021 8:02 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	11/21/2019 12:00:00 AM		3/9/2021 8:02 AM
Details	Entity Name	Update	Reinstatement	Ascension Seton d/b/a Dell Seton Medical Center at The University of Texas	DELL SETON MEDICAL CENTER AT THE UNI	3/9/2021 8:02 AM
Dates	Participating Approval Date	Update	Reinstatement	12/4/2007 12:00:00 AM	3/9/2021 8:02:31 AM	3/9/2021 8:02 AM
Details	State	Update	Reinstatement	Terminated	Approved	3/9/2021 8:02 AM
Dates	Registration Date	Update	Reinstatement	12/4/2007 12:00:00 AM	1/5/2021 11:10:12 AM	3/9/2021 8:02 AM
Dates	Signed By Date	Update	Reinstatement		3/8/2021 3:32:47 PM	3/9/2021 8:02 AM
Dates	Start Date	Update	Reinstatement	1/1/2000 12:00:00 AM	4/1/2021 12:00:00 AM	3/9/2021 8:02 AM
Terminations	Termination Date	Update	Reinstatement	1/1/2020 12:00:00 AM		3/9/2021 8:02 AM
Terminations	Termination Effective Date	Update	Reinstatement	11/21/2019 12:00:00 AM		3/9/2021 8:02 AM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		3/9/2021 8:02 AM
Details	Comments Public	Insert	Reinstatement		Participated starting 1/1/2000; Terminated 1/1/2020; Reinstated 4/1/2021.	3/8/2021 4:34 PM
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/21/2019 12:00:00 AM	12/4/2019 12:51 PM
Details	State	Update	Termination Request	Active	To Be Terminated	12/4/2019 12:51 PM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	12/4/2019 12:51 PM
Terminations	Termination Effective Date	Update	Termination Request		11/21/2019 12:00:00 AM	12/4/2019 12:51 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/4/2019 12:51 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 4:10:48 PM	9/9/2019 8:38:56 AM	9/9/2019 8:38 AM
Details	Entity Name	Update	Change Request	Dell Seton Medical Center at The University of Texas	Ascension Seton d/b/a Dell Seton Medical Center at The University of Texas	6/21/2019 1:13 PM
Contacts	Authorizing Official	Update	Change Request	Vasquez, Christann M President Seton 5123247074	Brierty, Timothy COO Dell Seton Medical Center at The University of Texas 5123247006	12/13/2018 9:27 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 10:38:21 AM	8/22/2018 4:10:48 PM	8/22/2018 4:10 PM
Contacts	Authorizing Official	Update	Change Request	Hernandez, Debra T VP, COO Dell Seton Medical Center 5123243082	Vasquez, Christann M President Seton 5123247074	6/18/2018 1:21 PM
Contacts	Primary Contact	Update	Recertification	Aziz, Shewan M. Senior Network Director of Pharmacy 5123247303	Aziz, Shewan M Senior Director of Pharmacy Seton Healthcare Family 5123247303	11/29/2017 10:38 AM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/29/2017 10:38:21 AM	11/29/2017 10:38 AM
Contacts	Authorizing Official	Insert	AO Change Request		Hernandez, Debra T VP, COO Dell Seton Medical Center 5123243082	11/28/2017 2:21 PM
Addresses	Main Address	Insert			1500 Red River Street AUSTIN, TX 78701	5/24/2017 1:58 PM
Contacts	Primary Contact	Insert			Aziz, Shewan M. Senior Network Director of Pharmacy 5123247303	5/24/2017 1:58 PM
Details	Entity Name	Update		BRACKENRIDGE HOSPITAL	Dell Seton Medical Center at The University of Texas	5/12/2017 6:46 AM
Details	Entity Subname	Update		UNIVERSITY MEDICAL CENTER AT BRACKENRIDGE		5/12/2017 6:46 AM
Medicaid Billing	Medicaid: State	Update		13	TX	11/29/2016 10:45 AM
Medicaid Billing	Medicaid: Number	Update		137265086	137265806	10/25/2016 4:40 PM
Medicaid Billing	Medicaid: State	Update		TX	13	10/25/2016 4:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/18/2016 5:56 PM
Medicaid Billing	Medicaid: Number	Insert			137265086	10/18/2016 5:56 PM
Medicaid Billing	Medicaid: State	Insert			TX	10/18/2016 5:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/18/2016 5:56 PM
Medicaid Billing	Medicaid: Number	Insert			137265083	10/18/2016 5:56 PM
Medicaid Billing	Medicaid: State	Insert			TX	10/18/2016 5:56 PM
Medicaid Billing	NPI: Number	Insert			1093810327	10/18/2016 5:56 PM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 11:28 AM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	8/6/2015 12:00:00 AM	8/6/2015 12:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	12/2/2014 11:17 AM
Medicaid Billing	Medicaid: Number	Insert			450124	12/2/2014 11:17 AM
Medicaid Billing	Medicaid: State	Insert			TX	12/2/2014 11:17 AM
Medicaid Billing	NPI: Number	Insert			1801950670	12/2/2014 11:17 AM
Details	Last Recertification Date	Update		8/27/2013 12:00:00 AM	8/20/2014 12:00:00 AM	8/20/2014 2:09 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/27/2013 12:00:00 AM	8/27/2013 1:36 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/18/2012 12:17 PM
Details	Last Recertification Date	Insert				8/16/2010 1:33 PM
Details	Grant Number	Insert				8/16/2010 1:33 PM
Details	340B ID	Insert			DSH450124	8/16/2010 1:33 PM
Details	Is Authorizing Official EHB Data	Insert				8/16/2010 1:33 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/16/2010 1:33 PM
Details	Medicare Provider Number	Insert			450124	8/16/2010 1:33 PM
Details	Entity Name	Insert			BRACKENRIDGE HOSPITAL	8/16/2010 1:33 PM
Details	Program Code	Insert			DSH	8/16/2010 1:33 PM
Details	Entity Subname	Insert			UNIVERSITY MEDICAL CENTER AT BRACKENRIDGE	8/16/2010 1:33 PM
Dates	Participating Approval Date	Insert			12/4/2007 12:00:00 AM	8/16/2010 1:33 PM
Details	State	Insert			Active	8/16/2010 1:33 PM
Dates	Registration Date	Insert			12/4/2007 12:00:00 AM	8/16/2010 1:33 PM
Dates	Signed By Date	Insert				8/16/2010 1:33 PM
Dates	Start Date	Insert			1/1/2000 12:00:00 AM	8/16/2010 1:33 PM
Terminations	Termination Comments	Insert				8/16/2010 1:33 PM
Terminations	Termination Date	Insert				8/16/2010 1:33 PM
Terminations	Termination Effective Date	Insert				8/16/2010 1:33 PM
Terminations	Termination Reason	Insert				8/16/2010 1:33 PM
Details	Comments Public	Insert			8/16/10 SUB-DIV NAME ADDED	8/16/2010 1:33 PM