Covered Entity Details

DSH450124A Ascension Seton d/b/a Dell Seton Medical Center at The University of Texas (Terminated) - information as of 4/29/2025 11:53:59 PM

Main Details

Name

Ascension Seton d/b/a Dell Seton Medical Center at The University of Texas

Subdivision Name

Seton Infusion Center, a Department of Dell Seton Medical Center at The University of Texas

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450124A

Medicare Provider Number

450124

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/4/2017

Participating Start Date

7/1/2017

Participating Approval Date

5/24/2017

Last Recertification Date

9/5/2019

Termination Date
Termination Reason

1/1/2020
DSH percentage below statutory minimum

Contacts

Authorizing Official

Dell Seton Medical Center at The University of Texas
Timothy Brierty, COO
(512) 324-7006

Primary Contact

Seton Healthcare Family
Shewan M Aziz, Senior Director of Pharmacy
(512) 324-7303

Addresses

Street Address

University of Texas at Austin Health Transformation Building
1601 Trinity Street, Suite 804
Austin, TX 78712-1850

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

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	450124,137265806
		1093810327

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

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
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 12:50 PM
Details	State	Update	Termination Request	Active	To Be Terminated	12/4/2019 12:50 PM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	12/4/2019 12:50 PM
Terminations	Termination Effective Date	Update	Termination Request		11/21/2019 12:00:00 AM	12/4/2019 12:50 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/4/2019 12:50 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 10:16:08 AM	9/5/2019 4:48:04 PM	9/5/2019 4:48 PM
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 10:38:56 AM	8/21/2018 10:16:08 AM	8/21/2018 10:16 AM
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		11/29/2017 10:38:56 AM	11/29/2017 10:38 AM
Details	Entity Name	Update	Recertification	UNIVERSITY MED CENTER BRACKENRIDGE	Dell Seton Medical Center at The University of Texas	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
Contacts	Signed By	Insert			Hernandez, Debra T. VP-COO & CNO SMCUT UMCB 5123243082	7/14/2017 12:13 PM
Addresses	Main Address	Insert			University of Texas at Austin Health Transformation Building 1601 Trinity Street, Suite 804 Austin, TX 78712-1850	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
Dates	Participating Approval Date	Update			5/24/2017 12:00:00 AM	5/24/2017 1:57 PM
Details	State	Update		Pending	Active	5/24/2017 1:57 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	5/24/2017 1:57 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_75869	DSH450124A	5/18/2017 2:44 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_75869	4/4/2017 11:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/4/2017 11:33 AM
Medicaid Billing	Medicaid: Number	Insert			450124	4/4/2017 11:33 AM
Medicaid Billing	Medicaid: State	Insert			TX	4/4/2017 11:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/4/2017 11:33 AM
Medicaid Billing	Medicaid: Number	Insert			137265806	4/4/2017 11:33 AM
Medicaid Billing	Medicaid: State	Insert			TX	4/4/2017 11:33 AM
Medicaid Billing	NPI: Number	Insert			1093810327	4/4/2017 11:33 AM
Details	Last Recertification Date	Insert				4/4/2017 11:33 AM
Details	Grant Number	Insert				4/4/2017 11:33 AM
Details	340B ID	Insert				4/4/2017 11:33 AM
Details	Is Authorizing Official EHB Data	Insert				4/4/2017 11:33 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/4/2017 11:33 AM
Details	Medicare Provider Number	Insert			450124	4/4/2017 11:33 AM
Details	Entity Name	Insert			UNIVERSITY MED CENTER BRACKENRIDGE	4/4/2017 11:33 AM
Details	Program Code	Insert			DSH	4/4/2017 11:33 AM
Details	Entity Subname	Insert			Seton Infusion Center, a Department of Dell Seton Medical Center at The University of Texas	4/4/2017 11:33 AM
Dates	Participating Approval Date	Insert				4/4/2017 11:33 AM
Details	State	Insert			Pending	4/4/2017 11:33 AM
Dates	Registration Date	Insert			4/4/2017 12:00:00 AM	4/4/2017 11:33 AM
Dates	Signed By Date	Insert			4/4/2017 12:00:00 AM	4/4/2017 11:33 AM
Dates	Start Date	Insert				4/4/2017 11:33 AM
Terminations	Termination Comments	Insert				4/4/2017 11:33 AM
Terminations	Termination Date	Insert				4/4/2017 11:33 AM
Terminations	Termination Effective Date	Insert				4/4/2017 11:33 AM
Terminations	Termination Reason	Insert				4/4/2017 11:33 AM