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AFFILIATED HEALTH SERVICES, 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
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
1/4/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Apryl Renee Haynes, COO/CNO
(830) 875-7041
Contract Pharmacy Representative
Ascension Michigan Pharmacy
Deborah Sopo, Pharmacy Manager
(248) 865-3770
Signed By Date
4/8/2020
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