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HENDRICK PHARMACY ON AMBLER
SCH450587-00 HENDRICK MEDICAL CENTER BROWNWOOD
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Covered Entity Details
Entity Name
HENDRICK MEDICAL CENTER BROWNWOOD
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450587-00
Entity Address
1501 BURNET DRIVE
BROWNWOOD, TX 76804
Medicare Provider Number
450587
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
HENDRICK PHARMACY ON AMBLER
Pharmacy Address
1265 AMBLER AVE
ABILENE, TX 79601
Pharmacy Comments
Contract Details
Approval Date
10/30/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erich Wallschlaeger, Chief Financial Officer
(325) 649-3305
Contract Pharmacy Representative
Hendrick Medical Center
Jeremy Walker, Chief Financial Officer
(325) 670-2207
Signed By Date
10/28/2024
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