Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
STD462012 DAMIEN CENTER INC, THE

Covered Entity Details

Entity Name

DAMIEN CENTER INC, THE

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD462012

Entity Address

26 N Arsenal Avenue
Indianapolis, IN 46201

Grant Number

NU62PS924804

Participating Start Date

10/1/2019

Last Recertification Date

5/5/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06607
105 E. OHIO 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

12/31/2019
Pharmacy closed

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