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WELLPARTNER, 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
WELLPARTNER, INC
Pharmacy Address
20800 SW 115TH AVE
SUITE 100
TUALATIN, OR 97062
Pharmacy Comments
Contract Details
Approval Date
10/14/2014
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
THOMAS E. GALLAGHER, PRESIDENT & CEO
(512) 324-1903
Contract Pharmacy Representative
Wellpartner, inc
Harish Thiagaraj, Senior Vice President of Pharmacy/Specialty Pharmacy
(503) 906-6887
Signed By Date
10/14/2014
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