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HOOK-SUPERX, L.L.C.
RRC150128-00 COMMUNITY HOSPITAL SOUTH
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL SOUTH
Subdivision Name
Type
Rural Referral Center
340B ID
RRC150128-00
Entity Address
1402 EAST COUNTY LINE ROAD
INDIANAPOLIS, IN 46227
Medicare Provider Number
150128
Participating Start Date
1/1/2021
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06654
8970 S. MERIDIAN ST.
INDIANAPOLIS, IN 46217
Pharmacy Comments
Contract Details
Approval Date
10/6/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/17/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David Kiley, President
(317) 621-9337
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/6/2021
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