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DSH450587B HENDRICK MEDICAL CENTER BROWNWOOD (Terminated)
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Main Details
Name
HENDRICK MEDICAL CENTER BROWNWOOD
Subdivision Name
Hendrick Wound Care Center Brownwood - Hendrick Wound Care Center Brownwood - 34225
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450587B
Medicare Provider Number
450587
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/29/2022
Last Recertification Date
8/20/2024
Termination Date
Termination Reason
1/1/2025
Change of covered entity type
Contacts
Authorizing Official
Hendrick Medical Center Brownood
Erich Wallschlaeger, Chief Financial Officer
(325) 649-3305
Primary Contact
Hendrick Medical Center
Robert Joseph Wray, pharmacist
(325) 670-6405
Addresses
Street Address
123 S Park Dr.
Brownwood, TX 76801
Billing Address
Hendrick Medical Center Brownwood
1501 Burnett Rd.
Brownwood, TX 76801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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