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SCH450229-06 HENDRICK MEDICAL CENTER (Terminated)
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Main Details
Name
HENDRICK MEDICAL CENTER
Subdivision Name
Hendrick Housecalls 12860 - Home Health
Type
Sole Community Hospital
Rural
No
340B ID
SCH450229-06
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
11/6/2024
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
1393 Ambler Avenue
Abilene, TX 79601
Billing Address
HENDRICK MEDICAL CENTRR
1900 PINE STREET
ABILENE, TX 79601-2432
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date2/15/2022, Termination 10/1/2022, Reinstatement 1/1/2025
11/05/2024
Participating Start Date2/8/2022, Termination 10/1/2022, Reinstatement 1/1/2025
10/10/2024
April 2025
April 2025
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