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HOOK-SUPERX, L.L.C.
DSH150007 COMMUNITY HOWARD REGIONAL HEALTH
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Covered Entity Details
Entity Name
COMMUNITY HOWARD REGIONAL HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150007
Entity Address
3500 SOUTH LAFOUNTAIN
KOKOMO, IN 46902
Medicare Provider Number
150007
Participating Start Date
1/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06667
201 SOUTH JACKSON STREET
FRANKFORT, IN 46041
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Hooper, President & CEO
(765) 776-8580
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2019
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