Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
FQHCLA419 Centerstone Health Services, Inc.

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 # 06645
101 WEST 1ST ST.
RUSHVILLE, IN 46173

Pharmacy Comments

Contract Details

Approval Date

10/16/2021

Contract Begin Date

10/26/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/21/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Robert Siegmann, Executive Director
(812) 344-4935

Contract Pharmacy Representative

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

Signed By Date

10/16/2021

340B Drug Pricing Program Database