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HOOK-SUPERX, L.L.C.
FQHCLA419 Centerstone Health Services, Inc.
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Covered Entity Details
Entity Name
Centerstone Health Services, Inc.
Subdivision Name
Centerstone Health Services - Connersville
Type
Health Center Program Look-Alike
340B ID
FQHCLA419
Entity Address
390 Erie Ave
Connersville, IN 47331-3177
Grant Number
LALCS40181
Participating Start Date
4/1/2021
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06636
298 SOUTH WEST 18TH ST.,
RICHMOND, IN 47374
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Robert Siegmann, Executive Director
(812) 344-4935
Contract Pharmacy Representative
CVS Health
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
10/12/2021
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