Covered Entity Details

MID COAST MEDICAL CENTER-CENTRAL (Rejected) - information as of 6/12/2025 6:00:40 AM

Main Details

Name

MID COAST MEDICAL CENTER-CENTRAL

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

Medicare Provider Number

451396

Additional Details

Current Program Status

Rejected

Registration Date

4/15/2025

Participating Start Date

Participating Approval Date

Last Recertification Date

Contacts

Authorizing Official

Llano Regional Hospital
Rob T Hardy, Interim Administrator
(512) 639-4444

Primary Contact

Llano Regional Hospital
David Willmann, Chairman
(325) 247-5701

Addresses

Street Address

200 N. OLLIE STREET
LLANO, TX 78643

Billing Address
Same as Street Address

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?
No

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
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update	New Registration	Pending	Rejected	4/29/2025 6:56 AM
Addresses	Main Address	Insert	New Registration		200 N. OLLIE STREET LLANO, TX 78643	4/15/2025 9:27 AM
Contacts	Authorizing Official	Insert	New Registration		Hardy, Rob T Interim Administrator Llano Regional Hospital 5126394444	4/15/2025 9:27 AM
Contacts	Primary Contact	Insert	New Registration		Willmann, David Chairman Llano Regional Hospital 3252475701	4/15/2025 9:27 AM
Details	Assistance Received From Date	Insert	New Registration			4/15/2025 9:27 AM
Details	Assistance Received To Date	Insert	New Registration			4/15/2025 9:27 AM
Details	Last Recertification Date	Insert	New Registration			4/15/2025 9:27 AM
Details	Grant Number	Insert	New Registration			4/15/2025 9:27 AM
Details	340B ID	Insert	New Registration			4/15/2025 9:27 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2025 9:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2025 9:27 AM
Details	Medicare Provider Number	Insert	New Registration		451396	4/15/2025 9:27 AM
Details	Entity Name	Insert	New Registration		MID COAST MEDICAL CENTER-CENTRAL	4/15/2025 9:27 AM
Details	NOFO Number	Insert	New Registration			4/15/2025 9:27 AM
Details	Program Code	Insert	New Registration		CAH	4/15/2025 9:27 AM
Details	Entity Subname	Insert	New Registration			4/15/2025 9:27 AM
Dates	Participating Approval Date	Insert	New Registration			4/15/2025 9:27 AM
Details	State	Insert	New Registration		Pending	4/15/2025 9:27 AM
Dates	Registration Date	Insert	New Registration		4/15/2025 9:27:53 AM	4/15/2025 9:27 AM
Dates	Signed By Date	Insert	New Registration			4/15/2025 9:27 AM
Dates	Start Date	Insert	New Registration			4/15/2025 9:27 AM
Terminations	Termination Comments	Insert	New Registration			4/15/2025 9:27 AM
Terminations	Termination Date	Insert	New Registration			4/15/2025 9:27 AM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2025 9:27 AM
Terminations	Termination Reason	Insert	New Registration			4/15/2025 9:27 AM