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HOOK-SUPERX, L.L.C.
DSH140093 OSF SACRED HEART MEDICAL CENTER
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Covered Entity Details
Entity Name
OSF SACRED HEART MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140093
Entity Address
812 NORTH LOGAN AVENUE
DANVILLE, IL 61832-3752
Medicare Provider Number
140093
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06669
511 THIRD ST.
COVINGTON, IN 47932
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2020
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