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HOOK-SUPERX, L.L.C.
DSH150051 IU HEALTH BLOOMINGTON HOSPITAL
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Covered Entity Details
Entity Name
IU HEALTH BLOOMINGTON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150051
Entity Address
2651 EAST DISCOVERY PARKWAY
BLOOMINGTON, IN 47408
Medicare Provider Number
150051
Participating Start Date
10/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06697
2701 EAST 3RD ST.
BLOOMINGTON, IN 47401
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer M. Alvey, SVP & CFO
(317) 963-0213
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2021
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