Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
DSH150113 COMMUNITY HOSPITAL ANDERSON

Covered Entity Details

Entity Name

COMMUNITY HOSPITAL ANDERSON

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150113

Entity Address

1515 NORTH MADISON AVE
ANDERSON, IN 46011

Medicare Provider Number

150113

Participating Start Date

4/1/2021

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06640
265 SO. SCATTERFIELD RD
ANDERSON, IN 46012

Pharmacy Comments

Contract Details

Approval Date

10/4/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Beth Tharp, SVP/President of Hospital Services
(765) 298-5125

Contract Pharmacy Representative

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

Signed By Date

10/4/2021

340B Drug Pricing Program Database