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WELLPARTNER, INC
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
WELLPARTNER, INC
Pharmacy Address
20800 SW 115TH AVE
SUITE 100
TUALATIN, OR 97062
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Herb A. Dyer, VP-COO
(512) 324-7006
Contract Pharmacy Representative
Wellpartner, inc
Harish Thiagaraj, Senior Vice President of Pharmacy/Specialty Pharmacy
(503) 906-6887
Signed By Date
10/15/2014
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