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HEB PHARMACY #735
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
HEB PHARMACY #735
Pharmacy Address
1503 HWY 1431 WEST
MARBLE FALLS, TX 78654
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
7/13/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Karen Litterer, VP-COO SHL
(512) 715-3008
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
7/17/2018
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