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HOOK-SUPERX, L.L.C.
CHC24133-00 MAPLE CITY HEALTH CARE CENTER, INC.
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Covered Entity Details
Entity Name
MAPLE CITY HEALTH CARE CENTER, INC.
Subdivision Name
Maple City Health Care Center
Type
HRSA-Funded Health Center
340B ID
CHC24133-00
Entity Address
213 Middlebury Street
Goshen, IN 46528-2956
Grant Number
H80CS24133
Participating Start Date
4/1/2013
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06460
3600 CASSOPOLIS ST.
ELKHART, IN 46514
Pharmacy Comments
Contract Details
Approval Date
7/8/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James N. Gingerich, Guardian of Vision
(574) 534-3300 Ext: 134
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/8/2019
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