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CVS PHARMACY, INC.
PED453310-00 Ascension Seton d/b/a Dell Children's Medical Center of Central Texas
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Covered Entity Details
Entity Name
Ascension Seton d/b/a Dell Children's Medical Center of Central Texas
Subdivision Name
Type
Children's Hospital
340B ID
PED453310-00
Entity Address
4900 MUELLER BOULEVARD
AUSTIN, TX 78723
Medicare Provider Number
453310
Participating Start Date
7/1/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 00213
5526 S. CONGRESS AVE.
AUSTIN, TX 78745
Pharmacy Comments
Contract Details
Approval Date
4/6/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Debra Marie Brown, VP, Patient Care Services and COO
(512) 324-0186
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/6/2021
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