Contract Pharmacy Details

WALGREEN CO.
DSH450867 Ascension Seton d/b/a Ascension Seton Northwest

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04836
11810 RR 620 N
AUSTIN, TX 78750

Pharmacy Comments

Contract Details

Approval Date

1/18/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tony DeDominico, COO
(512) 324-6046

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/18/2022

340B Drug Pricing Program Database