Covered Entity Details

SCH450229-05 HENDRICK MEDICAL CENTER (Terminated) - information as of 4/27/2025 11:36:47 PM

Main Details

Name

HENDRICK MEDICAL CENTER

Subdivision Name

CONGESTIVE HEART FAILURE - HMCN CHF 12274

Type

Sole Community Hospital

Rural

340B ID

SCH450229-05

Medicare Provider Number

450229

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/8/2024

Participating Start Date

1/1/2025

Participating Approval Date

11/4/2024

Last Recertification Date

Termination Date
Termination Reason

1/1/2025
Other

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

1150 N. 18th Street
400
Abilene, TX 79601

Billing Address

Hendrick Medical Center
1900 Pine Street
Abilene, TX 79601

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start Date 2/10/2022, Termination 10/1/2022, Reinstatement 1/1/2025	10/10/2024

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	138644305,138644306,138644307,138644309,38644310	1528064649

Shipping Addresses

Shipping Address 1

Hendrick Medical Center Pharmacy
1900 Pine Street
Pharmacy Room 5407
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
SCH450229-01	Child	SCH	HENDRICK MEDICAL CENTER	DIABETES SELF-MANAGEMENT TRAINING - HMCN Diabetes Center 17256	1742 Hickory Street	Abilene	TX	Terminated
SCH450229-02	Child	SCH	HENDRICK MEDICAL CENTER	HENDRICK PULMONARY REHABILITATION - HMCN Pulmonary Rehab 14235	1857 PINE ST	ABILENE	TX	Terminated
SCH450229-03	Child	SCH	HENDRICK MEDICAL CENTER	HENDRICK EMERGENCY CARE CTR SOUTH - Plaza ED 12911	5310 BUFFALO GAP RD	ABILENE	TX	Terminated
SCH450229-04	Child	SCH	HENDRICK MEDICAL CENTER	HENDRICK CARDIAC REHABILITATION - HMCN Cardiac Rehab 12266	1150 N 18TH STREET	Abilene	TX	Terminated
SCH450229-05	Child	SCH	HENDRICK MEDICAL CENTER	CONGESTIVE HEART FAILURE - HMCN CHF 12274	1150 N. 18th Street	Abilene	TX	Terminated
SCH450229-06	Child	SCH	HENDRICK MEDICAL CENTER	Hendrick Housecalls 12860 - Home Health	1393 Ambler Avenue	Abilene	TX	Terminated
SCH450229-07	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Operating Room - Operating Room	6250 US-83	Abilene	TX	Terminated
SCH450229-08	Child	SCH	HENDRICK MEDICAL CENTER	HMCS - Surgery Center - Surgery Center	6399 Directors Parkway	Abilene	TX	Terminated
SCH450229-09	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Post Anesthesia Care Unit - Post Anesthesia Care Unit	6250 US-83	Abilene	TX	Terminated
SCH450229-10	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Labor & Delivery-Recovery - Labor & Delivery	6250 US-83	Abilene	TX	Terminated
SCH450229-11	Child	SCH	HENDRICK MEDICAL CENTER	Anesthesia - Anesthesia	6250 US-83	Abilene	TX	Terminated
SCH450229-12	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Radiology-Diagnostic - Radiology-Diagnostic	6250 US-83	Abilene	TX	Terminated
SCH450229-13	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Radiology-Ultrasound - Radiology-Ultrasound	6250 US-83	Abilene	TX	Terminated
SCH450229-14	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Mammography - Mammography	6250 US-83	Abilene	TX	Terminated
SCH450229-15	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Interventional - Interventional	6250 US-83	Abilene	TX	Terminated
SCH450229-16	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Non-Invasive Cardiology - Non-Invasive Cardiology	6250 US-83	Abilene	TX	Terminated
SCH450229-17	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Respiratory Therapy - Respiratory Therapy	6250 US-83	Abilene	TX	Terminated
SCH450229-18	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Radiology-CT Scanner - Radiology-CT Scanner	6250 US-83	Abilene	TX	Terminated
SCH450229-19	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Radiology-Nuclear Medicine - Radiology-Nuclear Medicine	6250 US-83	Abilene	TX	Terminated
SCH450229-20	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Emergency Department - Emergency Department	6250 US-83	Abilene	TX	Terminated
SCH450229-21	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Cardiac Cath Lab - Cardiac Cath Lab	6250 US-83	Abilene	TX	Terminated
SCH450229-22	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Pulmonary Rehab/Lab - Pulmonary Rehab/Lab	6250 US-83	Abilene	TX	Terminated
SCH450229-23	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Oncology Infusion Service - Oncology Infusion Service	6250 US-83	Abilene	TX	Terminated
SCH450229-24	Child	SCH	HENDRICK MEDICAL CENTER	HMCS EEG/Sleep Lab - EEG/Sleep Lab	6250 US-83	Abilene	TX	Terminated
SCH450229-25	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Hyperbaric Medicine - Hyperbaric Medicine	6250 US-83	Abilene	TX	Terminated
SCH450229-26	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Radiology-MRI - Radiology-MRI	6250 US-83	Abilene	TX	Terminated
SCH450229-27	Child	SCH	HENDRICK MEDICAL CENTER	HMCS PICC Line Program - PICC Line Program	6250 US-83	Abilene	TX	Terminated
SCH450229-28	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Cardiac Rehab - Cardiac Rehab	6250 US-83	Abilene	TX	Terminated
SCH450229-29	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Renal Dialysis - Renal Dialysis	6250 US-83	Abilene	TX	Terminated
SCH450229-30	Child	SCH	HENDRICK MEDICAL CENTER	HMCS Non-Invasive Cardiology - 22270 - HMCS Non-Invasive Cardiology - 22270	1680 ANTILLEY RD	ABILENE	TX	Terminated
SCH450229-31	Child	SCH	HENDRICK MEDICAL CENTER	HENDRICK MEDICAL CENTER - Mammography-Vera West - Mammography-Vera West - 15460	1850 HICKORY ST	ABILENE	TX	Terminated
SCH450229-32	Child	SCH	HENDRICK MEDICAL CENTER	Non-Invasive Cardiology - HRT - 12270 - Non-Invasive Cardiology - HRT - 12270	1201 N 18TH ST	ABILENE	TX	Terminated
SCH450229-33	Child	SCH	HENDRICK MEDICAL CENTER	Radiology-MRI-Hendrick Medical Plaza - 15430 - Radiology-MRI-HMP - 15430	5302 BUFFALO GAP RD	ABILENE	TX	Terminated
SCH450229-34	Child	SCH	HENDRICK MEDICAL CENTER	Radiology-CT Scanner-Hendrick Medical Plaza - 15420 - Radiology-CT Scanner-HMP - 15420	5302 BUFFALO GAP RD	ABILENE	TX	Terminated
SCH450229-35	Child	SCH	HENDRICK MEDICAL CENTER	HMCN HOPD Cardiology Svs - 16100 - HMCN HOPD Cardiology Svs - 16100	1201 N 18TH ST	ABILENE	TX	Terminated
SCH450229-36	Child	SCH	HENDRICK MEDICAL CENTER	Radiology-Nuclear Medicine-HRT - 15435 - Radiology-Nuclear Medicine-HRT - 15435	1201 N 18TH ST	ABILENE	TX	Terminated
SCH450229-37	Child	SCH	HENDRICK MEDICAL CENTER	HMCS HOPD Cardiology Svs - 26100 - HMCS HOPD Cardiology Svs - 26100	1680 ANTILLEY RD	ABILENE	TX	Terminated
SCH450229-38	Child	SCH	HENDRICK MEDICAL CENTER	Radiology-CT Scanner-HIC - 15420 - Radiology-CT Scanner-HIC - 15420	750 NORTH 18TH	ABILENE	TX	Terminated
SCH450229-39	Child	SCH	HENDRICK MEDICAL CENTER	Radiology-MRI-HIC - 15430 - Radiology-MRI-HIC - 15430	750 NORTH 18TH	ABILENE	TX	Terminated
SCH450229-40	Child	SCH	HENDRICK MEDICAL CENTER	Radiology-Nuclear Medicine-HIC - 15435 - Radiology-Nuclear Medicine-HIC - 15435	750 NORTH 18th	ABILENE	TX	Terminated
SCH450229-41	Child	SCH	HENDRICK MEDICAL CENTER	Hendrick Dialysis Center - 12823 - Hendrick Dialysis Center - 12823	820 N 19TH STREET	ABILENE	TX	Terminated
SCH450229-42	Child	SCH	HENDRICK MEDICAL CENTER	Plaza Radiology Procedure Room - 15427 - Plaza Radiology Procedure Room - 15427	5302 Buffalo Gap Road	Abilene	TX	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/1/2024 12:00:00 AM	12/6/2024 2:18 PM
Details	State	Update	Termination Request	Approved	To Be Terminated	12/6/2024 2:18 PM
Terminations	Termination Comments	Update	Termination Request		Covered Entity was able to retain DSH levels above 11.75% on Medicare Cost Report and would like to retain DSH status. Terminating in keeping with email correspondence with Josh Volpe (HRSA).	12/6/2024 2:18 PM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	12/6/2024 2:18 PM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2024 12:00:00 AM	12/6/2024 2:18 PM
Terminations	Termination Reason	Update	Termination Request		Other	12/6/2024 2:18 PM
Addresses	Shipping Address	Update	Reinstatement	Hendrick Medical Center 1900 Pine Street 5407 Abilene, TX 79601	Hendrick Medical Center Pharmacy 1900 Pine Street Pharmacy Room 5407 Abilene, TX 79601	11/4/2024 3:50 PM
Addresses	Billing Address	Insert	Reinstatement		Hendrick Medical Center 1900 Pine Street Abilene, TX 79601	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Number	Delete	Reinstatement	138644310 (TX)		11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		138644305	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		138644306	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		138644307	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		138644309	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		38644310	11/4/2024 3:50 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	11/4/2024 3:50 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	10/1/2022 12:00:00 AM		11/4/2024 3:50 PM
Dates	Participating Approval Date	Update	Reinstatement	2/10/2022 8:11:03 AM	11/4/2024 3:50:29 PM	11/4/2024 3:50 PM
Details	State	Update	Reinstatement	Terminated	Approved	11/4/2024 3:50 PM
Dates	Registration Date	Update	Reinstatement	2/4/2022 5:32:32 PM	10/8/2024 10:56:51 AM	11/4/2024 3:50 PM
Dates	Signed By Date	Update	Reinstatement	2/9/2022 4:35:56 PM	10/8/2024 5:21:42 PM	11/4/2024 3:50 PM
Dates	Start Date	Update	Reinstatement	2/10/2022 12:00:00 AM	1/1/2025 12:00:00 AM	11/4/2024 3:50 PM
Terminations	Termination Date	Update	Reinstatement	10/1/2022 12:00:00 AM		11/4/2024 3:50 PM
Terminations	Termination Effective Date	Update	Reinstatement	10/1/2022 12:00:00 AM		11/4/2024 3:50 PM
Terminations	Termination Reason	Update	Reinstatement	Change of covered entity type		11/4/2024 3:50 PM
Details	Comments Public	Insert	Reinstatement		Participating Start Date 2/10/2022, Termination 10/1/2022, Reinstatement 1/1/2025	10/10/2024 10:08 AM
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	8/4/2022 5:11 PM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	8/4/2022 5:11 PM
Terminations	Termination Date	Update	Hospital Type Change Request		10/1/2022 12:00:00 AM	8/4/2022 5:11 PM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		10/1/2022 12:00:00 AM	8/4/2022 5:11 PM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	8/4/2022 5:11 PM
Details	State	Update	OPA Edit	Approved	Active	2/10/2022 8:12 AM
Dates	Start Date	Update	OPA Edit	4/1/2022 12:00:00 AM	2/10/2022 12:00:00 AM	2/10/2022 8:12 AM
Contacts	Signed By	Insert	New Registration		Walker, Jeremy Chief Financial Officer Hendrick Medical Center 3256702207	2/10/2022 8:11 AM
Details	340B ID	Update	New Registration		SCH450229-05	2/10/2022 8:11 AM
Details	Entity Subname	Update	New Registration	CONGESTIVE HEART FAILURE	CONGESTIVE HEART FAILURE - HMCN CHF 12274	2/10/2022 8:11 AM
Dates	Participating Approval Date	Update	New Registration		2/10/2022 8:11:03 AM	2/10/2022 8:11 AM
Details	State	Update	New Registration	Pending	Approved	2/10/2022 8:11 AM
Dates	Signed By Date	Update	New Registration		2/9/2022 4:35:56 PM	2/10/2022 8:11 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	2/10/2022 8:11 AM
Addresses	Main Address	Insert	New Registration		1150 N. 18th Street 400 Abilene, TX 79601	2/4/2022 5:32 PM
Addresses	Billing Address	Insert	New Registration		Hendrick Medical Center 1900 Pine Street Abilene, TX 79601	2/4/2022 5:32 PM
Addresses	Shipping Address	Insert	New Registration		Hendrick Medical Center 1900 Pine Street 5407 Abilene, TX 79601	2/4/2022 5:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	2/4/2022 5:32 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138644310	2/4/2022 5:32 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	2/4/2022 5:32 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1528064649	2/4/2022 5:32 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	2/4/2022 5:32 PM
Contacts	Primary Contact	Insert	New Registration		Wray, Robert Joseph pharmacist Hendrick Medical Center 3256706405	2/4/2022 5:32 PM
Contacts	Authorizing Official	Insert	New Registration		Walker, Jeremy Chief Financial Officer Hendrick Medical Center 3256702207	2/4/2022 5:32 PM
Details	Assistance Received From Date	Insert	New Registration			2/4/2022 5:32 PM
Details	Assistance Received To Date	Insert	New Registration			2/4/2022 5:32 PM
Details	Last Recertification Date	Insert	New Registration			2/4/2022 5:32 PM
Details	Grant Number	Insert	New Registration			2/4/2022 5:32 PM
Details	340B ID	Insert	New Registration			2/4/2022 5:32 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			2/4/2022 5:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			2/4/2022 5:32 PM
Details	Medicare Provider Number	Insert	New Registration		450229	2/4/2022 5:32 PM
Details	Entity Name	Insert	New Registration		HENDRICK MEDICAL CENTER	2/4/2022 5:32 PM
Details	NOFO Number	Insert	New Registration			2/4/2022 5:32 PM
Details	Program Code	Insert	New Registration		SCH	2/4/2022 5:32 PM
Details	Entity Subname	Insert	New Registration		CONGESTIVE HEART FAILURE	2/4/2022 5:32 PM
Dates	Participating Approval Date	Insert	New Registration			2/4/2022 5:32 PM
Details	State	Insert	New Registration		Pending	2/4/2022 5:32 PM
Dates	Registration Date	Insert	New Registration		2/4/2022 5:32:32 PM	2/4/2022 5:32 PM
Dates	Signed By Date	Insert	New Registration			2/4/2022 5:32 PM
Dates	Start Date	Insert	New Registration			2/4/2022 5:32 PM
Terminations	Termination Comments	Insert	New Registration			2/4/2022 5:32 PM
Terminations	Termination Date	Insert	New Registration			2/4/2022 5:32 PM
Terminations	Termination Effective Date	Insert	New Registration			2/4/2022 5:32 PM
Terminations	Termination Reason	Insert	New Registration			2/4/2022 5:32 PM