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HOOK-SUPERX, L.L.C.
CHC29005-03 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
CHC29005-03
Entity Address
3229 Broadway STE 160
Gary, IN 46409
Grant Number
H80CS29005
Participating Start Date
10/1/2019
Last Recertification Date
Entity Termination Date
1/1/2020
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
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
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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