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HOOK-SUPERX, L.L.C.
CAH151332-00 DECATUR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DECATUR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151332-00
Entity Address
720 NORTH LINCOLN STREET
GREENSBURG, IN 47240
Medicare Provider Number
151332
Participating Start Date
8/18/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06645
101 WEST 1ST ST.
RUSHVILLE, IN 46173
Pharmacy Comments
Contract Details
Approval Date
4/6/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rex McKinney, CEO
(812) 663-1171
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/6/2020
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