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HOOK-SUPERX, L.L.C.
CAH151330-00 ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151330-00
Entity Address
1100 MERCER AVE
DECATUR, IN 46733-0151
Medicare Provider Number
151330
Participating Start Date
9/14/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06515
1203 S. MAIN ST.
BLUFFTON, IN 46714
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JO-ELLEN EIDAM, CEO
(260) 724-2145 Ext: 11001
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2019
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