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HOOK-SUPERX, L.L.C.
CAH151305-00 PULASKI MEMORIAL HOSPITAL
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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 # 06906
107 N. CULLEN ST.
RENSSELAER, IN 47978
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
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