Covered Entity Details

SCH670108-10 BAYLOR SCOTT & WHITE - MARBLE FALLS (Active) - information as of 5/4/2025 10:26:41 PM

Main Details

Name

BAYLOR SCOTT & WHITE - MARBLE FALLS

Subdivision Name

BAYLOR SCOTT & WHITE CLINIC - LLANO / FAMILY MEDICINE

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH670108-10

Medicare Provider Number

670108

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/24/2024

Participating Start Date

4/1/2024

Participating Approval Date

3/11/2024

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Baylor Scott & White Medical Center - Marble Falls
Timothy Ols, President
(830) 201-8679

Primary Contact

Baylor Scott & White Medical Center - Marble Falls
Nola Finke, Mgr Pharmacy
(979) 220-0747

Addresses

Street Address

102 E YOUNG ST
LLANO, TX 78643

Billing Address

BAYLOR SCOTT & WHITE MEDICAL CENTER - MARBLE FALLS
810 W HIGHWAY 71
MARBLE FALLS, TX 78654

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
TX	2822678-03	1699076257,1396138970

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
SCH670108-01	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / PODIATRY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-02	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / PULMONOLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-03	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / RADIOLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-04	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / URGENT CARE	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-05	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / UROLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-06	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE CLINIC - SAN SABA / FAMILY MEDICINE	200 E WALLACE ST	SAN SABA	TX	Active
SCH670108-07	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE CLINIC - JOHNSON CITY / FAMILY MEDICINE	208 HALEY RD	JOHNSON CITY	TX	Active
SCH670108-08	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE CLINIC - HORSESHOE BAY / FAMILY MEDICINE	100 PECAN CROSSING DR	HORSESHOE BAY	TX	Active
SCH670108-09	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE CLINIC - KINGSLAND / FAMILY MEDICINE	105 FM 2342	KINGSLAND	TX	Active
SCH670108-10	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE CLINIC - LLANO / FAMILY MEDICINE	102 E YOUNG ST	LLANO	TX	Active
SCH670108-11	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE CLINIC - MARBLE FALLS / FAMILY MEDICINE	706 AVE G	MARBLE FALLS	TX	Active
SCH670108-12	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / NEPHROLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-13	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / VASCULAR SURGERY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-14	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / PAIN MEDICINE	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-15	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / OTOLARYNGOLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-16	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / ORTHOPAEDICS	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-17	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / OPHTHALMOLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-18	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / OBSTETRICS & GYNECOLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-19	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / HEMATOLOGY & ONCOLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-20	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / GENERAL SURGERY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-21	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / GASTROENTEROLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-22	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / ENDOCRINOLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-23	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / ECHO LAB	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-24	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / MEDICAL INFUSION	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-25	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / DERMATOLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-26	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / CARDIOLOGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active
SCH670108-27	Child	SCH	BAYLOR SCOTT & WHITE - MARBLE FALLS	BAYLOR SCOTT & WHITE SPECIALTY CLINIC - MARBLE FALLS / ALLERGY	800 W HIGHWAY 71	MARBLE FALLS	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Rosatti, Rosie Pharmacist Specialist Baylor Scott & White Medical Center - Marble Falls 5125227337	Finke, Nola Mgr Pharmacy Baylor Scott & White Medical Center - Marble Falls 9792200747	10/31/2024 7:12 AM
Details	Last Recertification Date	Update	Recertification		8/19/2024 3:03:14 PM	8/19/2024 3:03 PM
Details	Entity Subname	Update	Recertification	BAYLOR SCOTT & WHITE CLINIC - LLANO / - FAMILY MEDICINE	BAYLOR SCOTT & WHITE CLINIC - LLANO / FAMILY MEDICINE	8/19/2024 3:03 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Ols, Timothy President Baylor Scott & White Medical Center - Marble Falls 8302018679	3/11/2024 9:07 AM
Details	340B ID	Update	New Registration		SCH670108-10	3/11/2024 9:07 AM
Details	Entity Subname	Update	New Registration	BAYLOR SCOTT & WHITE CLINIC - LLANO /	BAYLOR SCOTT & WHITE CLINIC - LLANO / - FAMILY MEDICINE	3/11/2024 9:07 AM
Dates	Participating Approval Date	Update	New Registration		3/11/2024 9:07:59 AM	3/11/2024 9:07 AM
Details	State	Update	New Registration	Pending	Approved	3/11/2024 9:07 AM
Dates	Signed By Date	Update	New Registration		1/24/2024 2:05:15 PM	3/11/2024 9:07 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	3/11/2024 9:07 AM
Addresses	Main Address	Insert	New Registration		102 E YOUNG ST LLANO, TX 78643	1/24/2024 1:58 PM
Addresses	Billing Address	Insert	New Registration		BAYLOR SCOTT & WHITE MEDICAL CENTER - MARBLE FALLS 810 W HIGHWAY 71 MARBLE FALLS, TX 78654	1/24/2024 1:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/24/2024 1:58 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		2822678-03	1/24/2024 1:58 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/24/2024 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1699076257	1/24/2024 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	1/24/2024 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1396138970	1/24/2024 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	1/24/2024 1:58 PM
Contacts	Primary Contact	Insert	New Registration		Rosatti, Rosie Pharmacist Specialist Baylor Scott & White Medical Center - Marble Falls 5125227337	1/24/2024 1:58 PM
Contacts	Authorizing Official	Insert	New Registration		Ols, Timothy President Baylor Scott & White Medical Center - Marble Falls 8302018679	1/24/2024 1:58 PM
Details	Assistance Received From Date	Insert	New Registration			1/24/2024 1:58 PM
Details	Assistance Received To Date	Insert	New Registration			1/24/2024 1:58 PM
Details	Last Recertification Date	Insert	New Registration			1/24/2024 1:58 PM
Details	Grant Number	Insert	New Registration			1/24/2024 1:58 PM
Details	340B ID	Insert	New Registration			1/24/2024 1:58 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/24/2024 1:58 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/24/2024 1:58 PM
Details	Medicare Provider Number	Insert	New Registration		670108	1/24/2024 1:58 PM
Details	Entity Name	Insert	New Registration		BAYLOR SCOTT & WHITE - MARBLE FALLS	1/24/2024 1:58 PM
Details	NOFO Number	Insert	New Registration			1/24/2024 1:58 PM
Details	Program Code	Insert	New Registration		SCH	1/24/2024 1:58 PM
Details	Entity Subname	Insert	New Registration		BAYLOR SCOTT & WHITE CLINIC - LLANO /	1/24/2024 1:58 PM
Dates	Participating Approval Date	Insert	New Registration			1/24/2024 1:58 PM
Details	State	Insert	New Registration		Pending	1/24/2024 1:58 PM
Dates	Registration Date	Insert	New Registration		1/24/2024 1:58:25 PM	1/24/2024 1:58 PM
Dates	Signed By Date	Insert	New Registration			1/24/2024 1:58 PM
Dates	Start Date	Insert	New Registration			1/24/2024 1:58 PM
Terminations	Termination Comments	Insert	New Registration			1/24/2024 1:58 PM
Terminations	Termination Date	Insert	New Registration			1/24/2024 1:58 PM
Terminations	Termination Effective Date	Insert	New Registration			1/24/2024 1:58 PM
Terminations	Termination Reason	Insert	New Registration			1/24/2024 1:58 PM