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HOOK-SUPERX, L.L.C.
CAH151329-00 MARGARET MARY COMMUNITY HOSPITAL, INC.
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Covered Entity Details
Entity Name
MARGARET MARY COMMUNITY HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151329-00
Entity Address
321 MITCHELL AVE
BATESVILLE, IN 47006-0226
Medicare Provider Number
151329
Participating Start Date
9/28/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06077
405 GREEN BOULEVARD
AURORA, IN 47001
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRIAN DAEGER, CFO
(812) 933-5135
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2018
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