Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
RWII46201 Damien Cares

Covered Entity Details

Entity Name

Damien Cares

Subdivision Name

Type

Ryan White Part B

340B ID

RWII46201

Entity Address

26 N Arsenal Ave
Indianapolis, IN 46201

Grant Number

X07HA00033

Participating Start Date

10/1/2020

Last Recertification Date

2/9/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06604
175 N. ILLINOIS ST.
INDIANAPOLIS, IN 46204

Pharmacy Comments

Contract Details

Approval Date

8/13/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/11/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Alan Witchey, President and CEO
(317) 632-0123 Ext: 266

Contract Pharmacy Representative

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

Signed By Date

8/10/2020

340B Drug Pricing Program Database