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CVS PHARMACY, 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
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 03505
102 NORTH US 81
KYLE, TX 78640
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
Apryl Renee Haynes, COO/CNO
(830) 875-7041
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/6/2021
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