| Details | State | Update | | Approved | Active | 1/1/2025 12:01 AM |
| Addresses | Main Address | Insert | Reinstatement | |
105 Streckert Dr.
Brownwood, TX 76801 | 10/30/2024 10:15 AM |
| Addresses | Billing Address | Insert | Reinstatement | | Hendrick Medical Center Brownwood
1501 Burnett Rd.
Brownwood, TX 76801 | 10/30/2024 10:15 AM |
| Medicaid Billing | Medicaid: Number | Delete | Reinstatement | 20930601 (TX) | | 10/30/2024 10:15 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Reinstatement | | False | 10/30/2024 10:15 AM |
| Medicaid Billing | Medicaid: Number | Insert | Reinstatement | | 420957901 | 10/30/2024 10:15 AM |
| Medicaid Billing | Medicaid: State | Insert | Reinstatement | | TX | 10/30/2024 10:15 AM |
| Details | Last Recertification Date | Update | Reinstatement | 8/25/2021 5:48:29 PM | | 10/30/2024 10:15 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 10/1/2022 12:00:00 AM | | 10/30/2024 10:15 AM |
| Details | Entity Name | Update | Reinstatement | Hendrick Medical Center Brownwood | HENDRICK MEDICAL CENTER BROWNWOOD | 10/30/2024 10:15 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 3/22/2021 6:31:34 AM | 10/30/2024 10:15:51 AM | 10/30/2024 10:15 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 10/30/2024 10:15 AM |
| Dates | Registration Date | Update | Reinstatement | 3/16/2021 1:07:55 PM | 10/8/2024 4:42:25 PM | 10/30/2024 10:15 AM |
| Dates | Signed By Date | Update | Reinstatement | 3/19/2021 11:58:33 AM | 10/29/2024 4:30:42 PM | 10/30/2024 10:15 AM |
| Dates | Start Date | Update | Reinstatement | 3/22/2021 12:00:00 AM | 1/1/2025 12:00:00 AM | 10/30/2024 10:15 AM |
| Terminations | Termination Date | Update | Reinstatement | 10/1/2022 12:00:00 AM | | 10/30/2024 10:15 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 10/1/2022 12:00:00 AM | | 10/30/2024 10:15 AM |
| Terminations | Termination Reason | Update | Reinstatement | Change of covered entity type | | 10/30/2024 10:15 AM |
| Details | Comments Public | Insert | Reinstatement | | Participating from effective date: (03/22/2021) until terminated effective date: (10/01/2022), reinstatement effective date: (01/1/2025) | 10/28/2024 2:10 PM |
| Details | State | Update | | To Be Terminated | Terminated | 10/1/2022 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | | 10/1/2022 12:00:00 AM | 8/24/2022 11:34 AM |
| Details | State | Update | Hospital Type Change Request | Active | To Be Terminated | 8/24/2022 11:34 AM |
| Terminations | Termination Date | Update | Hospital Type Change Request | | 10/1/2022 12:00:00 AM | 8/24/2022 11:34 AM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | | 10/1/2022 12:00:00 AM | 8/24/2022 11:34 AM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | | Change of covered entity type | 8/24/2022 11:34 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/25/2021 5:48:29 PM | 8/25/2021 5:48 PM |
| Addresses | Main Address | Update | Change Request |
105 Streckert Dr.
Brownwood, TX 76804 |
105 Streckert Dr.
Brownwood, TX 76801 | 3/23/2021 11:21 AM |
| Details | Entity Name | Update | Change Request | BROWNWOOD REGIONAL MEDICAL CENTER | Hendrick Medical Center Brownwood | 3/22/2021 8:50 AM |
| Details | State | Update | OPA Edit | Approved | Active | 3/22/2021 6:33 AM |
| Dates | Start Date | Update | OPA Edit | 4/1/2021 12:00:00 AM | 3/22/2021 12:00:00 AM | 3/22/2021 6:33 AM |
| Addresses | Main Address | Insert | New Registration | |
105 Streckert Dr.
Brownwood, TX 76804 | 3/22/2021 6:31 AM |
| Addresses | Billing Address | Insert | New Registration | | Hendrick Medical Center Brownwood
1501 Burnett Rd.
Brownwood, TX 76801 | 3/22/2021 6:31 AM |
| Contacts | Signed By | Insert | New Registration | | Wallschlaeger, Erich
Chief Financial Officer
Hendrick Medical Center Brownood
3256493305 | 3/22/2021 6:31 AM |
| Details | 340B ID | Update | New Registration | | SCH450587-01 | 3/22/2021 6:31 AM |
| Details | Entity Subname | Update | New Registration | Hendrick Imaging and Breast Center Brownwood | Hendrick Imaging and Breast Center Brownwood - RADIOLOGY - REMOTE SITE 3 | 3/22/2021 6:31 AM |
| Dates | Participating Approval Date | Update | New Registration | | 3/22/2021 6:31:34 AM | 3/22/2021 6:31 AM |
| Details | State | Update | New Registration | Pending | Approved | 3/22/2021 6:31 AM |
| Dates | Signed By Date | Update | New Registration | | 3/19/2021 11:58:33 AM | 3/22/2021 6:31 AM |
| Dates | Start Date | Update | New Registration | | 4/1/2021 12:00:00 AM | 3/22/2021 6:31 AM |
| Addresses | Main Address | Insert | New Registration | |
105 Streckert Dr.
Brownwood, TX 76804 | 3/16/2021 1:07 PM |
| Addresses | Billing Address | Insert | New Registration | | Hendrick Medical Center Brownwood
1501 Burnett Rd.
Brownwood, TX 76801 | 3/16/2021 1:07 PM |
| Addresses | Shipping Address | Insert | New Registration | | Hendrick Medical Center Brownwood
1501 Burnett Rd.
Brownwood, TX 76801 | 3/16/2021 1:07 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 3/16/2021 1:07 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 20930601 | 3/16/2021 1:07 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | TX | 3/16/2021 1:07 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1184233785 | 3/16/2021 1:07 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | TX | 3/16/2021 1:07 PM |
| Contacts | Primary Contact | Insert | New Registration | | Wray, Robert Joseph
pharmacist
Hendrick Medical Center
3256706405 | 3/16/2021 1:07 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Wallschlaeger, Erich
Chief Financial Officer
Hendrick Medical Center Brownood
3256493305 | 3/16/2021 1:07 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Details | Grant Number | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Details | 340B ID | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 450587 | 3/16/2021 1:07 PM |
| Details | Entity Name | Insert | New Registration | | BROWNWOOD REGIONAL MEDICAL CENTER | 3/16/2021 1:07 PM |
| Details | NOFO Number | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Details | Program Code | Insert | New Registration | | SCH | 3/16/2021 1:07 PM |
| Details | Entity Subname | Insert | New Registration | | Hendrick Imaging and Breast Center Brownwood | 3/16/2021 1:07 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Details | State | Insert | New Registration | | Pending | 3/16/2021 1:07 PM |
| Dates | Registration Date | Insert | New Registration | | 3/16/2021 1:07:55 PM | 3/16/2021 1:07 PM |
| Dates | Signed By Date | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Dates | Start Date | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Terminations | Termination Date | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 3/16/2021 1:07 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 3/16/2021 1:07 PM |