Covered Entity Details

SCH450229-19 HENDRICK MEDICAL CENTER (Terminated) - information as of 4/28/2025 1:50:38 AM

Main Details

Name

HENDRICK MEDICAL CENTER

Subdivision Name

HMCS Radiology-Nuclear Medicine - Radiology-Nuclear Medicine

Type

Sole Community Hospital

Rural

340B ID

SCH450229-19

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

6250 US-83
Abilene, TX 79606

Billing Address

HENDRICK MEDICAL CENTER
1900 PINE STREET
ABILENE, TX 79601-2432

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start Date 7/1/2022, 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	138644310,138644305,138644306,138644307,138644309	1528064649

Shipping Addresses

Shipping Address 1

HENDRICK MEDICAL CENTER SOUTH PHARMACY
6250 US-83
PHARMACY
ABILENE, TX 79606

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	Billing Address	Insert	Reinstatement		HENDRICK MEDICAL CENTER 1900 PINE STREET ABILENE, TX 79601-2432	11/4/2024 4:04 PM
Addresses	Shipping Address	Insert	Reinstatement		HENDRICK MEDICAL CENTER SOUTH PHARMACY 6250 US-83 PHARMACY ABILENE, TX 79606	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		138644305	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		138644306	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		138644307	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		138644309	11/4/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	11/4/2024 4:04 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	10/1/2022 12:00:00 AM		11/4/2024 4:04 PM
Dates	Participating Approval Date	Update	Reinstatement	5/10/2022 2:43:16 PM	11/4/2024 4:04:47 PM	11/4/2024 4:04 PM
Details	State	Update	Reinstatement	Terminated	Approved	11/4/2024 4:04 PM
Dates	Registration Date	Update	Reinstatement	4/12/2022 12:46:04 PM	10/8/2024 11:57:15 AM	11/4/2024 4:04 PM
Dates	Signed By Date	Update	Reinstatement	4/12/2022 12:46:08 PM	10/8/2024 5:27:36 PM	11/4/2024 4:04 PM
Dates	Start Date	Update	Reinstatement	7/1/2022 12:00:00 AM	1/1/2025 12:00:00 AM	11/4/2024 4:04 PM
Terminations	Termination Date	Update	Reinstatement	10/1/2022 12:00:00 AM		11/4/2024 4:04 PM
Terminations	Termination Effective Date	Update	Reinstatement	10/1/2022 12:00:00 AM		11/4/2024 4:04 PM
Terminations	Termination Reason	Update	Reinstatement	Change of covered entity type		11/4/2024 4:04 PM
Details	Comments Public	Insert	Reinstatement		Participating Start Date 7/1/2022, Termination 10/1/2022, Reinstatement 1/1/2025	10/10/2024 10:16 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		Approved	Active	7/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Walker, Jeremy Chief Financial Officer Hendrick Medical Center 3256702207	5/10/2022 2:43 PM
Details	340B ID	Update	New Registration		SCH450229-19	5/10/2022 2:43 PM
Details	Entity Subname	Update	New Registration	HMCS Radiology-Nuclear Medicine	HMCS Radiology-Nuclear Medicine - Radiology-Nuclear Medicine	5/10/2022 2:43 PM
Dates	Participating Approval Date	Update	New Registration		5/10/2022 2:43:16 PM	5/10/2022 2:43 PM
Details	State	Update	New Registration	Pending	Approved	5/10/2022 2:43 PM
Dates	Signed By Date	Update	New Registration		4/12/2022 12:46:08 PM	5/10/2022 2:43 PM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	5/10/2022 2:43 PM
Addresses	Main Address	Insert	New Registration		6250 US-83 Abilene, TX 79606	4/12/2022 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2022 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138644310	4/12/2022 12:46 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/12/2022 12:46 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1528064649	4/12/2022 12:46 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	4/12/2022 12:46 PM
Contacts	Primary Contact	Insert	New Registration		Wray, Robert Joseph pharmacist Hendrick Medical Center 3256706405	4/12/2022 12:46 PM
Contacts	Authorizing Official	Insert	New Registration		Walker, Jeremy Chief Financial Officer Hendrick Medical Center 3256702207	4/12/2022 12:46 PM
Details	Assistance Received From Date	Insert	New Registration			4/12/2022 12:46 PM
Details	Assistance Received To Date	Insert	New Registration			4/12/2022 12:46 PM
Details	Last Recertification Date	Insert	New Registration			4/12/2022 12:46 PM
Details	Grant Number	Insert	New Registration			4/12/2022 12:46 PM
Details	340B ID	Insert	New Registration			4/12/2022 12:46 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/12/2022 12:46 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/12/2022 12:46 PM
Details	Medicare Provider Number	Insert	New Registration		450229	4/12/2022 12:46 PM
Details	Entity Name	Insert	New Registration		HENDRICK MEDICAL CENTER	4/12/2022 12:46 PM
Details	NOFO Number	Insert	New Registration			4/12/2022 12:46 PM
Details	Program Code	Insert	New Registration		SCH	4/12/2022 12:46 PM
Details	Entity Subname	Insert	New Registration		HMCS Radiology-Nuclear Medicine	4/12/2022 12:46 PM
Dates	Participating Approval Date	Insert	New Registration			4/12/2022 12:46 PM
Details	State	Insert	New Registration		Pending	4/12/2022 12:46 PM
Dates	Registration Date	Insert	New Registration		4/12/2022 12:46:04 PM	4/12/2022 12:46 PM
Dates	Signed By Date	Insert	New Registration			4/12/2022 12:46 PM
Dates	Start Date	Insert	New Registration			4/12/2022 12:46 PM
Terminations	Termination Comments	Insert	New Registration			4/12/2022 12:46 PM
Terminations	Termination Date	Insert	New Registration			4/12/2022 12:46 PM
Terminations	Termination Effective Date	Insert	New Registration			4/12/2022 12:46 PM
Terminations	Termination Reason	Insert	New Registration			4/12/2022 12:46 PM