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WALGREEN CO.
DSH450056 Ascension Seton d/b/a Ascension Seton Medical Center Austin
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Covered Entity Details
Entity Name
Ascension Seton d/b/a Ascension Seton Medical Center Austin
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450056
Entity Address
1201 WEST 38TH STREET
AUSTIN, TX 78705
Medicare Provider Number
450056
Participating Start Date
4/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05708
2650 R R 620
ROUND ROCK, TX 78681-5530
Pharmacy Comments
Contract Details
Approval Date
7/16/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tad Allen Hatton, VP/COO
(512) 484-3507
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2020
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