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HOOK-SUPERX, L.L.C.
CAH181310-00 CARROLL COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CARROLL COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181310-00
Entity Address
309 11TH STREET
CARROLLTON, KY 41008
Medicare Provider Number
181310
Participating Start Date
10/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06798
110 E. LA GRANGE RD.
HANOVER, IN 47243
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Dees, CEO
(502) 732-7411
Contract Pharmacy Representative
Wellpartner
Michael Petryna, National Sales Executive
(720) 377-7745
Signed By Date
10/11/2019
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