Covered Entity Details

SCH450587-02 HENDRICK MEDICAL CENTER BROWNWOOD (Active) - information as of 5/5/2025 11:53:46 PM

Main Details

Name

HENDRICK MEDICAL CENTER BROWNWOOD

Subdivision Name

Hendrick Wound Care Center Brownwood - HYPERBARIC OXYGEN

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH450587-02

Medicare Provider Number

450587

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/28/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/30/2024

Last Recertification Date

Contacts

Authorizing Official

Hendrick Medical Center Brownood
Erich Wallschlaeger, Chief Financial Officer
(325) 649-3305

Primary Contact

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

Addresses

Street Address

123 S Park Dr.
Brownwood, TX, TX 76801

Billing Address

Hendrick Medical Center Brownwood
1501 Burnett Rd.
Brownwood, TX 76801

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating from effective date: (03/22/2021) until terminated effective date; (10/01/2022); reinstatement effective date: (01/1/2025)	10/28/2024

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	420957901	1184233785

Shipping Addresses

Shipping Address 1

Hendrick Medical Center Brownwood
1501 Burnett Rd.
Brownwood, TX 76801

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
SCH450587-01	Child	SCH	HENDRICK MEDICAL CENTER BROWNWOOD	Hendrick Imaging and Breast Center Brownwood - RADIOLOGY - REMOTE SITE 3	105 Streckert Dr.	Brownwood	TX	Active
SCH450587-02	Child	SCH	HENDRICK MEDICAL CENTER BROWNWOOD	Hendrick Wound Care Center Brownwood - HYPERBARIC OXYGEN	123 S Park Dr.	Brownwood, TX	TX	Active
SCH450587-03	Child	SCH	Hendrick Medical Center Brownwood	Hendrick Outpatient Rehabilitation Brownwood - PHYSICAL THERAPY - REMOTE 1	101 Streckert Dr.	Brownwood	TX	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	1/1/2025 12:01 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 5:47:56 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 6:34:44 AM	10/30/2024 10:15:22 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 1:28:44 PM	10/28/2024 10:44:48 AM	10/30/2024 10:15 AM
Dates	Signed By Date	Update	Reinstatement	3/19/2021 11:59:18 AM	10/28/2024 2:00:27 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 2:18 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 5:47:56 PM	8/25/2021 5:47 PM
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 6:36 AM
Dates	Start Date	Update	OPA Edit	4/1/2021 12:00:00 AM	3/22/2021 12:00:00 AM	3/22/2021 6:36 AM
Addresses	Main Address	Insert	New Registration		123 S Park Dr. Brownwood, TX, TX 76801	3/22/2021 6:34 AM
Addresses	Billing Address	Insert	New Registration		Hendrick Medical Center Brownwood 1501 Burnett Rd. Brownwood, TX 76801	3/22/2021 6:34 AM
Contacts	Signed By	Insert	New Registration		Wallschlaeger, Erich Chief Financial Officer Hendrick Medical Center Brownood 3256493305	3/22/2021 6:34 AM
Details	340B ID	Update	New Registration		SCH450587-02	3/22/2021 6:34 AM
Details	Entity Subname	Update	New Registration	Hendrick Wound Care Center Brownwood	Hendrick Wound Care Center Brownwood - HYPERBARIC OXYGEN	3/22/2021 6:34 AM
Dates	Participating Approval Date	Update	New Registration		3/22/2021 6:34:44 AM	3/22/2021 6:34 AM
Details	State	Update	New Registration	Pending	Approved	3/22/2021 6:34 AM
Dates	Signed By Date	Update	New Registration		3/19/2021 11:59:18 AM	3/22/2021 6:34 AM
Dates	Start Date	Update	New Registration		4/1/2021 12:00:00 AM	3/22/2021 6:34 AM
Addresses	Main Address	Insert	New Registration		123 S Park Dr. Brownwood, TX, TX 76801	3/16/2021 1:28 PM
Addresses	Billing Address	Insert	New Registration		Hendrick Medical Center Brownwood 1501 Burnett Rd. Brownwood, TX 76801	3/16/2021 1:28 PM
Addresses	Shipping Address	Insert	New Registration		Hendrick Medical Center Brownwood 1501 Burnett Rd. Brownwood, TX 76801	3/16/2021 1:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	3/16/2021 1:28 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		20930601	3/16/2021 1:28 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	3/16/2021 1:28 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1184233785	3/16/2021 1:28 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	3/16/2021 1:28 PM
Contacts	Primary Contact	Insert	New Registration		Wray, Robert Joseph pharmacist Hendrick Medical Center 3256706405	3/16/2021 1:28 PM
Contacts	Authorizing Official	Insert	New Registration		Wallschlaeger, Erich Chief Financial Officer Hendrick Medical Center Brownood 3256493305	3/16/2021 1:28 PM
Details	Assistance Received From Date	Insert	New Registration			3/16/2021 1:28 PM
Details	Assistance Received To Date	Insert	New Registration			3/16/2021 1:28 PM
Details	Last Recertification Date	Insert	New Registration			3/16/2021 1:28 PM
Details	Grant Number	Insert	New Registration			3/16/2021 1:28 PM
Details	340B ID	Insert	New Registration			3/16/2021 1:28 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			3/16/2021 1:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			3/16/2021 1:28 PM
Details	Medicare Provider Number	Insert	New Registration		450587	3/16/2021 1:28 PM
Details	Entity Name	Insert	New Registration		BROWNWOOD REGIONAL MEDICAL CENTER	3/16/2021 1:28 PM
Details	NOFO Number	Insert	New Registration			3/16/2021 1:28 PM
Details	Program Code	Insert	New Registration		SCH	3/16/2021 1:28 PM
Details	Entity Subname	Insert	New Registration		Hendrick Wound Care Center Brownwood	3/16/2021 1:28 PM
Dates	Participating Approval Date	Insert	New Registration			3/16/2021 1:28 PM
Details	State	Insert	New Registration		Pending	3/16/2021 1:28 PM
Dates	Registration Date	Insert	New Registration		3/16/2021 1:28:44 PM	3/16/2021 1:28 PM
Dates	Signed By Date	Insert	New Registration			3/16/2021 1:28 PM
Dates	Start Date	Insert	New Registration			3/16/2021 1:28 PM
Terminations	Termination Comments	Insert	New Registration			3/16/2021 1:28 PM
Terminations	Termination Date	Insert	New Registration			3/16/2021 1:28 PM
Terminations	Termination Effective Date	Insert	New Registration			3/16/2021 1:28 PM
Terminations	Termination Reason	Insert	New Registration			3/16/2021 1:28 PM