Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CHC02456-00 WINDROSE HEALTH NETWORK, INC.

Covered Entity Details

Entity Name

WINDROSE HEALTH NETWORK, INC.

Subdivision Name

Windrose Health Network - Trafalgar

Type

HRSA-Funded Health Center

340B ID

CHC02456-00

Entity Address

14 Trafalgar Sq
Trafalgar, IN 46181-9515

Grant Number

H80CS02456

Participating Start Date

10/1/2016

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06551
523 SOUTH STATE ROAD 67
MOORESVILLE, IN 46158

Pharmacy Comments

Contract Details

Approval Date

1/13/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Scott K Rollett, CEO
(317) 739-4895 Ext: 2401

Contract Pharmacy Representative

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

Signed By Date

1/13/2021

340B Drug Pricing Program Database