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RRC450229-02 HENDRICK MEDICAL CENTER (Terminated)
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Main Details
Name
HENDRICK MEDICAL CENTER
Subdivision Name
HENDRICK EMERGENCY CARE CTR SOUTH
Type
Rural Referral Center
Rural
No
340B ID
RRC450229-02
Medicare Provider Number
450229
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/18/2019
Last Recertification Date
8/25/2020
Termination Date
Termination Reason
7/1/2021
DSH percentage below statutory minimum
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
5310 BUFFALO GAP RD
ABILENE, TX 79606-4130
Billing Address
Hendrick Medical Center
1900 Pine Street
Abilene, TX 79601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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