Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
DSH150011 MARION GENERAL HOSPITAL, INC.

Covered Entity Details

Entity Name

MARION GENERAL HOSPITAL, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150011

Entity Address

441 NORTH WABASH AVENUE
MARION, IN 46952

Medicare Provider Number

150011

Participating Start Date

7/1/2010

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02484
4630 SO. WASHINGTON ST.
MARION, IN 46953

Pharmacy Comments

Contract Details

Approval Date

7/12/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeff Wakefield, CFO
(765) 660-7003

Contract Pharmacy Representative

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

Signed By Date

7/12/2019

340B Drug Pricing Program Database