Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
HV00112 DAMIEN CENTER INC, THE

Covered Entity Details

Entity Name

DAMIEN CENTER INC, THE

Subdivision Name

Type

Ryan White Part C

340B ID

HV00112

Entity Address

DAMIEN CENTER INC
26 N ARSENAL AVE
Indianapolis, IN 46201

Grant Number

H76HA45371

Participating Start Date

4/1/2013

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06604
175 N. ILLINOIS ST.
INDIANAPOLIS, IN 46204

Pharmacy Comments

Contract Details

Approval Date

10/9/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/11/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Alan Witchey, President and CEO
(317) 632-0123 Ext: 266

Contract Pharmacy Representative

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

Signed By Date

10/9/2019

340B Drug Pricing Program Database