Covered Entity Details

DSH450229AU HENDRICK MEDICAL CENTER (Approved) - information as of 5/13/2025 1:46:18 AM

Main Details

Name

HENDRICK MEDICAL CENTER

Subdivision Name

HMCN Texas Midwest Surgery Center - 12378 - HMCN Texas Midwest Surgery Center - 12378

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450229AU

Medicare Provider Number

450229

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/8/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/5/2025

Last Recertification Date

Contacts

Authorizing Official

Hendrick Medical Center
Jeremy Walker, Chief Financial Officer
(325) 670-2207

Primary Contact

Hendrick Medical Center
Robert Joseph Wray, pharmacist
(325) 670-6405

Addresses

Street Address

751 N 18th St
Abilene, TX 79601

Billing Address

Hendrick Medical Center
1900 PINE ST
Abilene, TX 79601

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	138644310	1528064649

Shipping Addresses

Shipping Address 1

Hendrick Medical Center
1900 PINE ST
Abilene, TX 79601

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
DSH450229A	Child	DSH	HENDRICK MEDICAL CENTER	Congestive Heart Failure - Congestive Heart Failure - 12274	1150 N. 18th Street	Abilene	TX	Active
DSH450229AA	Child	DSH	HENDRICK MEDICAL CENTER	HMCS - Surgery Center - HMCS - Surgery Center - 22376	6399 Directors Parkway Suite 100	ABILENE	TX	Active
DSH450229AB	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Radiology-Diagnostic - HMCS Radiology-Diagnostic - 25425	6250 US-83	ABILENE	TX	Active
DSH450229AC	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Cardiac Rehab - HMCS Cardiac Rehab - 22266	6250 US-83	ABILENE	TX	Active
DSH450229AD	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Radiology-Nuclear Medicin - HMCS Radiology-Nuclear Medicin - 25435	6250 US-83	ABILENE	TX	Active
DSH450229AE	Child	DSH	HENDRICK MEDICAL CENTER	Cardiac Rehab - Cardiac Rehab - 12266	1150 N 18TH STREET	ABILENE	TX	Active
DSH450229AF	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Post Anesthesia Care Unit - HMCS Post Anesthesia Care Unit - 22380	6250 US-83	ABILENE	TX	Active
DSH450229AG	Child	DSH	HENDRICK MEDICAL CENTER	Plaza Pain Procedure Suites - 15427	5302 Buffalo Gap Road	Abilene	TX	Active
DSH450229AH	Child	DSH	HENDRICK MEDICAL CENTER	Hendrick Dialysis Center - 12823 - Hendrick Dialysis Center - 12823	820 N 19th Street	Abilene	TX	Active
DSH450229AJ	Child	DSH	HENDRICK MEDICAL CENTER	Radiology-Nuclear Medicine-HIC - 15435 - Radiology-Nuclear Medicine-HIC - 15435	750 North 18th	Abilene	TX	Active
DSH450229AK	Child	DSH	HENDRICK MEDICAL CENTER	Radiology-MRI-HIC - 15430 - Radiology-MRI-HIC - 15430	750 North 18th	Abilene	TX	Active
DSH450229AL	Child	DSH	HENDRICK MEDICAL CENTER	Radiology-CT Scanner-HIC - 15420 - Radiology-CT Scanner-HIC - 15420	750 North 18th	Abilene	TX	Active
DSH450229AM	Child	DSH	HENDRICK MEDICAL CENTER	HMCS HOPD Cardiology Svs - 26100 - HMCS HOPD Cardiology Svs - 26100	1680 Antilley Rd	Abilene	TX	Active
DSH450229AN	Child	DSH	HENDRICK MEDICAL CENTER	Radiology-Nuclear Medicine-HRT - 15435 - Radiology-Nuclear Medicine-HRT - 15435	1201 N 18th St	Abilene	TX	Active
DSH450229AP	Child	DSH	HENDRICK MEDICAL CENTER	HMCN HOPD Cardiology Svs - 16100 - HMCN HOPD Cardiology Svs - 16100	1201 N 18th St	Abilene	TX	Active
DSH450229AQ	Child	DSH	HENDRICK MEDICAL CENTER	Radiology-CT Scanner-Hendrick Medical Plaza - 15420 - Radiology-CT Scanner-HMP - 15420	5302 Buffalo Gap Rd	Abilene	TX	Active
DSH450229AR	Child	DSH	HENDRICK MEDICAL CENTER	Radiology-MRI-Hendrick Medical Plaza - 15430 - Radiology-MRI-HMP - 15430	5302 Buffalo Gap Rd	Abilene	TX	Active
DSH450229AS	Child	DSH	HENDRICK MEDICAL CENTER	Non-Invasive Cardiology - HRT - 12270	1201 N 18th St	Abilene	TX	Active
DSH450229AT	Child	DSH	HENDRICK MEDICAL CENTER	HMCN MMC Cedar Mall 2 - 15011 - HMCN MMC Cedar Mall 2 - 15011	1150 N 18th St, Ste 200	Abilene	TX	Approved
DSH450229AU	Child	DSH	HENDRICK MEDICAL CENTER	HMCN Texas Midwest Surgery Center - 12378 - HMCN Texas Midwest Surgery Center - 12378	751 N 18th St	Abilene	TX	Approved
DSH450229AV	Child	DSH	HENDRICK MEDICAL CENTER	HMCS MMC MOB - 15011 - HMCS Medication Management Clinic Medical Office Building - 15011	1680 Antilley Rd, Ste 270	Abilene	TX	Approved
DSH450229AW	Child	DSH	HENDRICK MEDICAL CENTER	HMCN MMC Cedar Mall 3 - 15011 - HMCN Medication Management Clinic Cedar Mall 3 - 15011	1150 N 18th St, Ste 300	Abilene	TX	Approved
DSH450229AX	Child	DSH	HENDRICK MEDICAL CENTER	HMCS CHF - 22274 - HMCS Congestive Heart Failure - 22274	1680 Antilley Rd, Ste 260	Abilene	TX	Approved
DSH450229AY	Child	DSH	HENDRICK MEDICAL CENTER	HMCN MMC Lancaster Plaza - 15011 - HMCN Medication Management Clinic Lancaster Plaza - 15011	5302 Buffalo Gap Rd	Abilene	TX	Approved
DSH450229AZ	Child	DSH	HENDRICK MEDICAL CENTER	HMCN MMC Diabetes Center - 15011 - HMCN Medication Management Clinic Diabetes Center - 15011	1742 Hickory St	Abilene	TX	Approved
DSH450229B	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Oncology Infusion Service - HMCS Oncology Infusion Service - 22825	6250 US-83	ABILENE	TX	Active
DSH450229C	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Respiratory Therapy - HMCS Respiratory Therapy - 24240	6250 US-83	ABILENE	TX	Active
DSH450229D	Child	DSH	HENDRICK MEDICAL CENTER	HMCS EEG/Sleep Lab - HMCS EEG/Sleep Lab - 24220	6250 US-83	ABILENE	TX	Active
DSH450229E	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Mammography - HMCS Mammography - 25460	6250 US-83	ABILENE	TX	Active
DSH450229F	Child	DSH	HENDRICK MEDICAL CENTER	Plaza ED - Plaza ED - 12911	5310 BUFFALO GAP RD	ABILENE	TX	Active
DSH450229G	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Radiology-Ultrasound - HMCS Radiology-Ultrasound - 25455	6250 US-83	ABILENE	TX	Active
DSH450229H	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Pulmonary Rehab/Lab - HMCS Pulmonary Rehab/Lab - 24235	6250 US-83	ABILENE	TX	Active
DSH450229J	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Emergency Department - HMCS Emergency Department - 22910	6250 US-83	ABILENE	TX	Active
DSH450229K	Child	DSH	HENDRICK MEDICAL CENTER	HMCS PICC Line Program - HMCS PICC Line Program - 22329	6250 US-83	ABILENE	TX	Active
DSH450229L	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Cardiac Cath Lab - HMCS Cardiac Cath Lab - 22260	6250 US-83	ABILENE	TX	Active
DSH450229M	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Interventional - HMCS Interventional - 25426	6250 US-83	ABILENE	TX	Active
DSH450229N	Child	DSH	HENDRICK MEDICAL CENTER	Diabetes Self Management Trng - Diabetes Self Management Trng - 17256	1742 Hickory Street	ABILENE	TX	Active
DSH450229P	Child	DSH	HENDRICK MEDICAL CENTER	Hsecalls Medicare-Skilled Nurs - Hsecalls Medicare-Skilled Nurs - 12864	1393 Ambler Avenue	Abilene	TX	Active
DSH450229Q	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Labor & Delivery-Recovery - HMCS Labor & Delivery-Recovery - 22410	6250 US-83	ABILENE	TX	Active
DSH450229R	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Radiology-CT Scanner - HMCS Radiology-CT Scanner - 25420	6250 US-83	ABILENE	TX	Active
DSH450229S	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Renal Dialysis - HMCS Renal Dialysis - 22290	6250 US-83	ABILENE	TX	Active
DSH450229T	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Radiology-MRI - HMCS Radiology-MRI - 25430	6250 US-83	ABILENE	TX	Active
DSH450229U	Child	DSH	HENDRICK MEDICAL CENTER	Anesthesia - Anesthesia - 22360	6250 US-83	ABILENE	TX	Active
DSH450229V	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Operating Room - HMCS Operating Room - 22375	6250 US-83	ABILENE	TX	Active
DSH450229W	Child	DSH	HENDRICK MEDICAL CENTER	Mammography-Vera West - Mammography-Vera West - 15460	1850 Hickory St	Abilene	TX	Active
DSH450229X	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Non-Invasive Cardiology - HMCS Non-Invasive Cardiology - 22270	1680 Antilley Rd	ABILENE	TX	Active
DSH450229Y	Child	DSH	HENDRICK MEDICAL CENTER	Pulmonary Rehab/Lab - Pulmonary Rehab/Lab - 14235	1857 PINE ST	ABILENE, TX	TX	Active
DSH450229Z	Child	DSH	HENDRICK MEDICAL CENTER	HMCS Hyperbaric Medicine - HMCS Hyperbaric Medicine - 24225	6250 US-83	ABILENE	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Walker, Jeremy Chief Financial Officer Hendrick Medical Center 3256702207	5/5/2025 9:11 AM
Details	340B ID	Update	New Registration		DSH450229AU	5/5/2025 9:11 AM
Details	Entity Subname	Update	New Registration	HMCN Texas Midwest Surgery Center - 12378	HMCN Texas Midwest Surgery Center - 12378 - HMCN Texas Midwest Surgery Center - 12378	5/5/2025 9:11 AM
Dates	Participating Approval Date	Update	New Registration		5/5/2025 9:11:58 AM	5/5/2025 9:11 AM
Details	State	Update	New Registration	Pending	Approved	5/5/2025 9:11 AM
Dates	Signed By Date	Update	New Registration		4/9/2025 9:25:58 AM	5/5/2025 9:11 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/5/2025 9:11 AM
Addresses	Main Address	Insert	New Registration		751 N 18th St Abilene, TX 79601	4/8/2025 3:52 PM
Addresses	Billing Address	Insert	New Registration		Hendrick Medical Center 1900 PINE ST Abilene, TX 79601	4/8/2025 3:52 PM
Addresses	Shipping Address	Insert	New Registration		Hendrick Medical Center 1900 PINE ST Abilene, TX 79601	4/8/2025 3:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/8/2025 3:52 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138644310	4/8/2025 3:52 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/8/2025 3:52 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1528064649	4/8/2025 3:52 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	4/8/2025 3:52 PM
Contacts	Primary Contact	Insert	New Registration		Wray, Robert Joseph pharmacist Hendrick Medical Center 3256706405	4/8/2025 3:52 PM
Contacts	Authorizing Official	Insert	New Registration		Walker, Jeremy Chief Financial Officer Hendrick Medical Center 3256702207	4/8/2025 3:52 PM
Details	Assistance Received From Date	Insert	New Registration			4/8/2025 3:52 PM
Details	Assistance Received To Date	Insert	New Registration			4/8/2025 3:52 PM
Details	Last Recertification Date	Insert	New Registration			4/8/2025 3:52 PM
Details	Grant Number	Insert	New Registration			4/8/2025 3:52 PM
Details	340B ID	Insert	New Registration			4/8/2025 3:52 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/8/2025 3:52 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/8/2025 3:52 PM
Details	Medicare Provider Number	Insert	New Registration		450229	4/8/2025 3:52 PM
Details	Entity Name	Insert	New Registration		HENDRICK MEDICAL CENTER	4/8/2025 3:52 PM
Details	NOFO Number	Insert	New Registration			4/8/2025 3:52 PM
Details	Program Code	Insert	New Registration		DSH	4/8/2025 3:52 PM
Details	Entity Subname	Insert	New Registration		HMCN Texas Midwest Surgery Center - 12378	4/8/2025 3:52 PM
Dates	Participating Approval Date	Insert	New Registration			4/8/2025 3:52 PM
Details	State	Insert	New Registration		Pending	4/8/2025 3:52 PM
Dates	Registration Date	Insert	New Registration		4/8/2025 3:52:07 PM	4/8/2025 3:52 PM
Dates	Signed By Date	Insert	New Registration			4/8/2025 3:52 PM
Dates	Start Date	Insert	New Registration			4/8/2025 3:52 PM
Terminations	Termination Comments	Insert	New Registration			4/8/2025 3:52 PM
Terminations	Termination Date	Insert	New Registration			4/8/2025 3:52 PM
Terminations	Termination Effective Date	Insert	New Registration			4/8/2025 3:52 PM
Terminations	Termination Reason	Insert	New Registration			4/8/2025 3:52 PM