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ACARIAHEALTH PHARMACY #11, INC
CAH451371-00 Ascension Seton d/b/a Ascension Seton Edgar B. Davis
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Covered Entity Details
Entity Name
Ascension Seton d/b/a Ascension Seton Edgar B. Davis
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451371-00
Entity Address
130 HAYS STREET
LULING, TX 78648-3207
Medicare Provider Number
451371
Participating Start Date
8/19/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ACARIAHEALTH PHARMACY #11, INC
Pharmacy Address
1311 W SAM HOUSTON PKWY N STE 130
HOUSTON, TX 77043-4015
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
12/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Apryl Renee Haynes, COO/CNO
(830) 875-7041
Contract Pharmacy Representative
Acaria Health
Jeril Kurian, Pharmacist In Charge
(800) 511-5144
Signed By Date
7/2/2018
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