340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-3569
DSH450056 Ascension Seton d/b/a Ascension Seton Medical Center Austin
Print
Covered Entity Details
Entity Name
Ascension Seton d/b/a Ascension Seton Medical Center Austin
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450056
Entity Address
1201 WEST 38TH STREET
AUSTIN, TX 78705
Medicare Provider Number
450056
Participating Start Date
4/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3569
Pharmacy Address
12900 N I-35 SERVICE RD SB
AUSTIN (NW), TX 78753
Pharmacy Comments
Contract Details
Approval Date
7/2/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/8/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tad Allen Hatton, VP/COO
(512) 484-3507
Contract Pharmacy Representative
Wal-mart
Laura Levine, Manager Contracting
(479) 204-8550
Signed By Date
7/2/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session