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HOOK-SUPERX, L.L.C.
CHC02456-06 WINDROSE HEALTH NETWORK, INC.
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Covered Entity Details
Entity Name
WINDROSE HEALTH NETWORK, INC.
Subdivision Name
Windrose Health Network - Edinburgh
Type
HRSA-Funded Health Center
340B ID
CHC02456-06
Entity Address
911 E Main Cross St
Edinburgh, IN 46124-1501
Grant Number
H80CS02456
Participating Start Date
7/1/2019
Last Recertification Date
2/1/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06757
2423 N. NATIONAL RD.
COLUMBUS, IN 47201
Pharmacy Comments
Contract Details
Approval Date
1/11/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Covered Entity Terminated
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
1/11/2020
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