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HOOK-SUPERX, L.L.C.
FQHCLA354 ASPIRE HEALTH CENTER
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Covered Entity Details
Entity Name
ASPIRE HEALTH CENTER
Subdivision Name
Aspire Indiana Health - Carmel
Type
Health Center Program Look-Alike
340B ID
FQHCLA354
Entity Address
697 Pro-med Lane
Carmel, IN 46032-5323
Grant Number
LALCS31260
Participating Start Date
1/1/2018
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06542
4026 S 00 EW
KOKOMO, IN 46902
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerry Landers, VP, Strategy & Business Development
(317) 587-0508
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2021
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