Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CAH151305-00 PULASKI MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

PULASKI MEMORIAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH151305-00

Entity Address

616 E. 13TH STREET
WINAMAC, IN 46996

Medicare Provider Number

151305

Participating Start Date

8/9/2010

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06534
717 NORTH 3RD STREET
LOGANSPORT, IN 46947

Pharmacy Comments

Contract Details

Approval Date

4/9/2020

Contract Begin Date

5/15/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

GREGG Alan MALOTT, DIRECTOR OF BUSINESS DEVELOPMENT
(574) 946-2103

Contract Pharmacy Representative

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

Signed By Date

4/9/2020

340B Drug Pricing Program Database