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ASCENSION RX 1001
DSH450867 Ascension Seton d/b/a Ascension Seton Northwest
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Covered Entity Details
Entity Name
Ascension Seton d/b/a Ascension Seton Northwest
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450867
Entity Address
11113 RESEARCH BLVD
AUSTIN, TX 78759-5297
Medicare Provider Number
450867
Participating Start Date
7/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
ASCENSION RX 1001
Pharmacy Address
ASCENSION PHARMACY SERVICES, LLC.
7701 METROPOLIS DR STE 200B
AUSTIN, TX 78744-3125
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony DeDominico, COO
(512) 324-6046
Contract Pharmacy Representative
Ascension Pharmacy Services, LLC
Lynn Eschenbacher, Chief Pharmacy Officer
(314) 884-0593
Signed By Date
7/14/2021
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