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HOOK-SUPERX, L.L.C.
CHC02456-03 WINDROSE HEALTH NETWORK, INC.
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Covered Entity Details
Entity Name
WINDROSE HEALTH NETWORK, INC.
Subdivision Name
Windrose Health Network - Countyline
Type
HRSA-Funded Health Center
340B ID
CHC02456-03
Entity Address
8921 Southpointe Drive, Suite A-1
Indianapolis, IN 46227-1084
Grant Number
H80CS02456
Participating Start Date
10/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04468
7935 S EMERSON AVENUE
SUITE B
INDIANAPOLIS, IN 46237
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott K Rollett, CEO
(317) 739-4895 Ext: 2401
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2019
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