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ASCENSION SETON CENTRAL OUTPATIENT PHARM
CAH451365-00 Ascension Seton d/b/a Ascension Seton Highland Lakes
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Covered Entity Details
Entity Name
Ascension Seton d/b/a Ascension Seton Highland Lakes
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451365-00
Entity Address
3201 S WATER STREET
BURNET, TX 78611-4510
Medicare Provider Number
451365
Participating Start Date
8/25/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ASCENSION SETON CENTRAL OUTPATIENT PHARM
Pharmacy Address
1500 RED RIVER ST
SUITE 14052
AUSTIN, TX 78701
Pharmacy Comments
Contract Details
Approval Date
8/3/2012
Contract Begin Date
8/3/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Arie Dejong, VP-COO Regional
(512) 715-3009
Contract Pharmacy Representative
Pat Garrett, Director of Pharmacy Operations
(512) 324-7365
Signed By Date
7/13/2012
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