Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
DSH150074 Community Health Network, Inc.

Covered Entity Details

Entity Name

Community Health Network, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150074

Entity Address

1500 N. RITTER AVE.
INDIANAPOLIS, IN 46219

Medicare Provider Number

150074

Participating Start Date

4/1/2008

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08643
1030 N ARLINGTON AVE
INDIANAPOLIS, IN 46219

Pharmacy Comments

Contract Details

Approval Date

10/15/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/8/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Scott L. Teffeteller, President, East Region
(317) 355-3390

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/15/2018

340B Drug Pricing Program Database