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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11131
200 S. COLORADO ST.
LOCKHART, TX 78644-2733
Pharmacy Comments
Contract Details
Approval Date
9/17/2015
Contract Begin Date
9/17/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
THOMAS E. GALLAGHER, PRESIDENT & CEO
(512) 324-1903
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
9/17/2015
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