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SCH450229-05 HENDRICK MEDICAL CENTER (Terminated)
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Main Details
Name
HENDRICK MEDICAL CENTER
Subdivision Name
CONGESTIVE HEART FAILURE - HMCN CHF 12274
Type
Sole Community Hospital
Rural
No
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
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Participating Start Date 2/10/2022, Termination 10/1/2022, Reinstatement 1/1/2025
10/10/2024
April 2025
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