Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CAH231315-00 ASCENSION BORGESS-LEE HOSPITAL

Covered Entity Details

Entity Name

ASCENSION BORGESS-LEE HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH231315-00

Entity Address

420 WEST HIGH STREET
DOWAGIAC, MI 49047

Medicare Provider Number

231315

Participating Start Date

9/30/2010

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06464
210 N. MAIN ST.
MISHAWAKA, IN 46544

Pharmacy Comments

Contract Details

Approval Date

1/15/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/21/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Natalie C Ryder, Chief Administrative Officer
(269) 783-3080

Contract Pharmacy Representative

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

Signed By Date

1/15/2021

340B Drug Pricing Program Database