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HOOK-SUPERX, L.L.C.
CHC29005-01 PORTER STARKE SERVICES INC
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Covered Entity Details
Entity Name
PORTER STARKE SERVICES INC
Subdivision Name
Marram Health Center
Type
HRSA-Funded Health Center
340B ID
CHC29005-01
Entity Address
3229 Broadway Ste 115
Gary, IN 46409-1040
Grant Number
H80CS29005
Participating Start Date
7/1/2019
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06483
1407 LINCOLNWAY
LAPORTE, IN 46350
Pharmacy Comments
Contract Details
Approval Date
10/3/2019
Contract Begin Date
10/8/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aileen Wehren, VP Systems Administration
(219) 476-4567
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/3/2019
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