Covered Entity Details

DSH450152E AdventHealth Central Texas (Active) - information as of 5/19/2025 12:56:03 AM

Main Details

Name

AdventHealth Central Texas

Subdivision Name

AdventHealth Wound Care Center Harker Heights

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450152E

Medicare Provider Number

450152

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/16/2017

Participating Start Date

1/1/2018

Participating Approval Date

10/18/2017

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

AdventHealth Central Texas
Janet Garcia, Chief Financial Officer
(682) 459-7140

Primary Contact

AdventHealth
Dustin Lott Jones, 340B Coordinator
(254) 833-1495

Addresses

Street Address

5610 East Central Texas Expressway
Suite 5
Killeen, TX 76549

Billing Address

AdventHealth Central Texas
c/o AdventHealth
902 Inspiration Ave
Suite 9100
Altamonte Springs, FL 32714

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	094119702	1629089966

Shipping Addresses

Shipping Address 1

AdventHealth Central Texas
2201 S. Clear Creek Rd
Killeen, TX 76549

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
DSH450152A	Child	DSH	AdventHealth Central Texas	AdventHealth Imaging Harker Heights	5610 E Central Texas Expressway	Killeen	TX	Active
DSH450152B	Child	DSH	AdventHealth Central Texas	AdventHealth Wound Care Killeen	2300 S Clear Creek Rd	Killeen	TX	Active
DSH450152C	Child	DSH	AdventHealth Central Texas	AdventHealth Behavioral Health Center	2407 South Clear Creek Rd	Killeen	TX	Active
DSH450152D	Child	DSH	METROPLEX HOSPITAL	Metroplex Home Health Agency	2115 S. Clear Creek Rd.	Killeen	TX	Terminated
DSH450152E	Child	DSH	AdventHealth Central Texas	AdventHealth Wound Care Center Harker Heights	5610 East Central Texas Expressway	Killeen	TX	Active
DSH450152F	Child	DSH	AdventHealth Central Texas	ADVENTHEALTH MEDICAL GROUP PSYCHIAT - AdventHealth Medical Group Psychiatry & Psychology at Killeen	2407 S CLEAR CREEK RD	KILLEEN	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	PC Change Request	King, Jerry F Director of Pharmacy AdventHealth Central Texas, AdventHealth Rollins Brook 2545198282	Jones, Dustin Lott 340B Coordinator AdventHealth 2548331495	3/26/2025 6:17 AM
Details	Last Recertification Date	Update	Recertification	9/6/2023 8:15:24 PM	9/4/2024 5:28:17 PM	9/4/2024 5:28 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 12:26:15 PM	9/6/2023 8:15:24 PM	9/6/2023 8:15 PM
Contacts	Authorizing Official	Update	Change Request	Pridgen, Parker COO/CFO AdventHealth Central Texas 2545198165	Garcia, Janet Chief Financial Officer AdventHealth Central Texas 6824597140	7/26/2023 5:58 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 9:20:50 AM	9/6/2022 12:26:15 PM	9/6/2022 12:26 PM
Details	Last Recertification Date	Update	Recertification	9/10/2020 11:56:11 AM	9/7/2021 9:20:50 AM	9/7/2021 9:20 AM
Addresses	Shipping Address	Insert	Change Request		AdventHealth Central Texas 2201 S. Clear Creek Rd Killeen, TX 76549	10/6/2020 2:48 PM
Medicaid Billing	NPI: State	Update	Recertification		TX	9/10/2020 11:56 AM
Details	Last Recertification Date	Update	Recertification	9/9/2019 1:53:01 PM	9/10/2020 11:56:11 AM	9/10/2020 11:56 AM
Addresses	Billing Address	Update	Change Request	AdventHealth Wound Care Center Harker Heights c/o Adventist Health System 902 Inspiration Ave Suite 9100 Altamonte Springs, FL 32714	AdventHealth Central Texas c/o AdventHealth 902 Inspiration Ave Suite 9100 Altamonte Springs, FL 32714	10/18/2019 12:43 PM
Addresses	Main Address	Update	Change Request	AdventHealth Would Care Center Harker Heights 5610 East Central Texas Expressway, Suite 5 Killeen, TX 76549	5610 East Central Texas Expressway Suite 5 Killeen, TX 76549	10/16/2019 6:38 AM
Addresses	Billing Address	Update	Change Request	AdventHealth Would Care Center Harker Heights c/o Adventist Health System 902 Inspiration Ave Suite 9100 Altamonte Springs, FL 32714	AdventHealth Wound Care Center Harker Heights c/o Adventist Health System 902 Inspiration Ave Suite 9100 Altamonte Springs, FL 32714	10/16/2019 6:38 AM
Contacts	Primary Contact	Insert	Change Request		King, Jerry F Director of Pharmacy AdventHealth Central Texas, AdventHealth Rollins Brook 2545198282	10/16/2019 6:38 AM
Addresses	Main Address	Update	Change Request	AdventHealth Would Care Center Harker Heights 5610 East Central Texas Expressway Suite 5 Killeen, TX 76543	AdventHealth Would Care Center Harker Heights 5610 East Central Texas Expressway, Suite 5 Killeen, TX 76549	10/9/2019 7:15 AM
Details	Last Recertification Date	Update	Recertification	9/11/2018 10:14:12 AM	9/9/2019 1:53:01 PM	9/9/2019 1:53 PM
Addresses	Main Address	Update	Change Request	5610 East Central Texas Expressway Suite 5 Harker Heights, TX 76548	AdventHealth Would Care Center Harker Heights 5610 East Central Texas Expressway Suite 5 Killeen, TX 76543	8/16/2019 2:33 PM
Addresses	Billing Address	Update	Change Request	Metroplex Hospital--Open MRI Harker heights c/o Adventist Health System 902 Inspiration Ave Suite 9100 Altamonte Springs, FL 32714	AdventHealth Would Care Center Harker Heights c/o Adventist Health System 902 Inspiration Ave Suite 9100 Altamonte Springs, FL 32714	8/16/2019 2:33 PM
Details	Entity Subname	Update	Change Request	Metroplex Wound Care - Harker Heights - Wound Care	AdventHealth Wound Care Center Harker Heights	8/16/2019 2:33 PM
Contacts	Authorizing Official	Update	AO Change Request	Brock, Robert CFO Metroplex Health System 2545198165	Pridgen, Parker COO/CFO AdventHealth Central Texas 2545198165	7/2/2019 6:33 AM
Details	Entity Name	Update	Change Request	METROPLEX HOSPITAL	AdventHealth Central Texas	3/28/2019 12:52 PM
Addresses	Billing Address	Insert	Recertification		Metroplex Hospital--Open MRI Harker heights c/o Adventist Health System 902 Inspiration Ave Suite 9100 Altamonte Springs, FL 32714	9/11/2018 10:14 AM
Details	Last Recertification Date	Update	Recertification		9/11/2018 10:14:12 AM	9/11/2018 10:14 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/1/2017 8:49 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		094119702	11/1/2017 8:49 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	11/1/2017 8:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1629089966	11/1/2017 8:49 AM
Details	State	Update	Change Request	Approved	Active	11/1/2017 8:49 AM
Contacts	Signed By	Insert	New Registration		Brock, Robert CFO Metroplex Health System 2545198165	10/18/2017 1:13 PM
Details	340B ID	Update	New Registration		DSH450152E	10/18/2017 1:13 PM
Details	Entity Subname	Update	New Registration	Metroplex Wound Care - Harker Heights	Metroplex Wound Care - Harker Heights - Wound Care	10/18/2017 1:13 PM
Dates	Participating Approval Date	Update	New Registration		10/18/2017 1:13:04 PM	10/18/2017 1:13 PM
Details	State	Update	New Registration	Pending	Approved	10/18/2017 1:13 PM
Dates	Signed By Date	Update	New Registration		10/16/2017 3:41:52 PM	10/18/2017 1:13 PM
Dates	Start Date	Update	New Registration		1/1/2018 12:00:00 AM	10/18/2017 1:13 PM
Addresses	Main Address	Insert	New Registration		5610 East Central Texas Expressway Suite 5 Harker Heights, TX 76548	10/16/2017 3:41 PM
Contacts	Authorizing Official	Insert	New Registration		Brock, Robert CFO Metroplex Health System 2545198165	10/16/2017 3:41 PM
Details	Last Recertification Date	Insert	New Registration			10/16/2017 3:41 PM
Details	Grant Number	Insert	New Registration			10/16/2017 3:41 PM
Details	340B ID	Insert	New Registration			10/16/2017 3:41 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/16/2017 3:41 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/16/2017 3:41 PM
Details	Medicare Provider Number	Insert	New Registration		450152	10/16/2017 3:41 PM
Details	Entity Name	Insert	New Registration		METROPLEX HOSPITAL	10/16/2017 3:41 PM
Details	Program Code	Insert	New Registration		DSH	10/16/2017 3:41 PM
Details	Entity Subname	Insert	New Registration		Metroplex Wound Care - Harker Heights	10/16/2017 3:41 PM
Dates	Participating Approval Date	Insert	New Registration			10/16/2017 3:41 PM
Details	State	Insert	New Registration		Pending	10/16/2017 3:41 PM
Dates	Registration Date	Insert	New Registration		10/16/2017 3:41:49 PM	10/16/2017 3:41 PM
Dates	Signed By Date	Insert	New Registration			10/16/2017 3:41 PM
Dates	Start Date	Insert	New Registration			10/16/2017 3:41 PM
Terminations	Termination Comments	Insert	New Registration			10/16/2017 3:41 PM
Terminations	Termination Date	Insert	New Registration			10/16/2017 3:41 PM
Terminations	Termination Effective Date	Insert	New Registration			10/16/2017 3:41 PM
Terminations	Termination Reason	Insert	New Registration			10/16/2017 3:41 PM