Contract Pharmacy Details

HEB PHARMACY #161
DSH450867 Ascension Seton d/b/a Ascension Seton Northwest

Covered Entity Details

Entity Name

Ascension Seton d/b/a Ascension Seton Northwest

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450867

Entity Address

11113 RESEARCH BLVD
AUSTIN, TX 78759-5297

Medicare Provider Number

450867

Participating Start Date

7/1/2015

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

HEB PHARMACY #161

Pharmacy Address

7112 ED BLUESTEIN
AUSTIN, TX 78723

Pharmacy Comments

Contract Details

Approval Date

7/17/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/18/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Margaret Elaine Butler, COO
(512) 324-6046

Contract Pharmacy Representative

HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578

Signed By Date

7/17/2018

340B Drug Pricing Program Database