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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04704
4501 GUADALUPE ST.
AUSTIN, TX 78751
Pharmacy Comments
Contract Details
Approval Date
10/31/2012
Contract Begin Date
10/31/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/3/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARK L. HAZELWOOD, PRESIDENT AND CEO
(512) 324-4055
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/31/2012
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