Contract Pharmacy Details

WALGREEN CO.
CAH451371-04 Ascension Seton d/b/a Ascension Seton Edgar B. Davis

Covered Entity Details

Entity Name

Ascension Seton d/b/a Ascension Seton Edgar B. Davis

Subdivision Name

SETON HEALTHCARE D/B/A SETON LOCKHART FAMILY HEALTH CENTER

Type

Critical Access Hospital

340B ID

CAH451371-04

Entity Address

300 S. Colorado, Suite A, B, C, & D
LOCKHART, TX 78644-2707

Medicare Provider Number

451371

Outpatient Facility Provider Number

Participating Start Date

1/1/2021

Last Recertification Date

8/28/2024

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

4/8/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2017

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

4/8/2013

340B Drug Pricing Program Database