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WAL-MART PHARMACY 10-5315
CAH451365-00 Ascension Seton d/b/a Ascension Seton Highland Lakes
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Covered Entity Details
Entity Name
Ascension Seton d/b/a Ascension Seton Highland Lakes
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451365-00
Entity Address
3201 S WATER STREET
BURNET, TX 78611-4510
Medicare Provider Number
451365
Participating Start Date
8/25/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
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
Karen Litterer, VP-COO SHL
(512) 715-3008
Contract Pharmacy Representative
Wal-mart
Laura Levine, Manager Contracting
(479) 204-8550
Signed By Date
7/2/2018
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