Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CH0514720 RAPHAEL HEALTH CENTER, Inc.

Covered Entity Details

Entity Name

RAPHAEL HEALTH CENTER, Inc.

Subdivision Name

RAPHAEL HEALTH CENTER, Inc.

Type

HRSA-Funded Health Center

340B ID

CH0514720

Entity Address

401 E 34th St
Indianapolis, IN 46205-3754

Grant Number

H80CS00266

Participating Start Date

7/1/2004

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00684
7930 MADISON AVE.
INDIANAPOLIS, IN 46227

Pharmacy Comments

Contract Details

Approval Date

1/14/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Sherry Gray, Chief Executive Officer
(317) 860-3962

Contract Pharmacy Representative

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

Signed By Date

1/14/2020

340B Drug Pricing Program Database