Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CAH151307-00 ST. VINCENT WILLIAMSPORT HOSPITAL d/b/a Ascension St. Vincent Williamsport

Covered Entity Details

Entity Name

ST. VINCENT WILLIAMSPORT HOSPITAL d/b/a Ascension St. Vincent Williamsport

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH151307-00

Entity Address

412 N. MONROE STREET
WILLIAMSPORT, IN 47993

Medicare Provider Number

151307

Participating Start Date

1/1/2011

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06673
200 WEST JACKSON STREET
ATTICA, IN 47918

Pharmacy Comments

Contract Details

Approval Date

10/13/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Trina L Marlatt, Administrator
(765) 762-4003

Contract Pharmacy Representative

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

Signed By Date

10/13/2021

340B Drug Pricing Program Database