Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CHC02456-06 WINDROSE HEALTH NETWORK, INC.

Covered Entity Details

Entity Name

WINDROSE HEALTH NETWORK, INC.

Subdivision Name

Windrose Health Network - Edinburgh

Type

HRSA-Funded Health Center

340B ID

CHC02456-06

Entity Address

911 E Main Cross St
Edinburgh, IN 46124-1501

Grant Number

H80CS02456

Participating Start Date

7/1/2019

Last Recertification Date

2/1/2022

Entity Termination Date

1/1/2023

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06739
860 WEST MORGAN STREET
SPENCER, IN 47460

Pharmacy Comments

Contract Details

Approval Date

10/11/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Scott K Rollett, CEO
(317) 739-4895 Ext: 2401

Contract Pharmacy Representative

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

Signed By Date

10/11/2021

340B Drug Pricing Program Database