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AFFILIATED HEALTH SERVICES, INC.
DSH450867 Ascension Seton d/b/a Ascension Seton Northwest
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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
AFFILIATED HEALTH SERVICES, INC.
Pharmacy Address
DBA ASCENSION RX 1303
30055 NORTHWESTERN HWY
STE 225
FARMINGTON HILLS, MI 48334
Pharmacy Comments
Contract Details
Approval Date
4/8/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Margaret Elaine Butler, COO
(512) 324-6046
Contract Pharmacy Representative
Ascension Michigan Pharmacy
Deborah Sopo, Pharmacy Manager
(248) 865-3770
Signed By Date
4/8/2020
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