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ASCENSION SETON CENTRAL OUTPATIENT PHARM
DSH450124 Dell Seton Medical Center at The University of Texas
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Covered Entity Details
Entity Name
Dell Seton Medical Center at The University of Texas
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450124
Entity Address
1500 RED RIVER ST
AUSTIN, TX 78701
Medicare Provider Number
450124
Participating Start Date
3/11/2021
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
ASCENSION SETON CENTRAL OUTPATIENT PHARM
Pharmacy Address
1500 RED RIVER ST
SUITE 14052
AUSTIN, TX 78701
Pharmacy Comments
Contract Details
Approval Date
4/5/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Brierty, COO
(512) 324-7006
Contract Pharmacy Representative
Seton Family of Hospitals
Brandy McGinnis, Area Dir of Continuity of Care
(512) 745-2291
Signed By Date
4/5/2021
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