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HOOK-SUPERX, L.L.C.
CHC33650-00 SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
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Covered Entity Details
Entity Name
SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
Subdivision Name
SICHC Paoli
Type
HRSA-Funded Health Center
340B ID
CHC33650-00
Entity Address
420 W Longest St
Paoli, IN 47454-8821
Grant Number
H80CS33650
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06875
930 N. GOSPEL ST
PAOLI, IN 47454
Pharmacy Comments
Contract Details
Approval Date
2/28/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nancy Radcliff, CEO
(812) 723-3944
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
2/27/2020
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