Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

JANE PAULEY COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Jane Pauley Community Health Center

Type

HRSA-Funded Health Center

340B ID

CHC26566-00

Entity Address

8931 E. 30th Street
Indianapolis, IN 46219-1501

Grant Number

H80CS26566

Participating Start Date

4/1/2014

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06654
8970 S. MERIDIAN ST.
INDIANAPOLIS, IN 46217

Pharmacy Comments

Contract Details

Approval Date

1/2/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Dale Marion, 340B Program Manager
(317) 552-0690

Contract Pharmacy Representative

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

Signed By Date

1/2/2020

340B Drug Pricing Program Database