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HOOK-SUPERX, L.L.C.
FQHCLA419A Centerstone Health Services, Inc.
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Covered Entity Details
Entity Name
Centerstone Health Services, Inc.
Subdivision Name
Centerstone Health Services
Type
Health Center Program Look-Alike
340B ID
FQHCLA419A
Entity Address
645 S Rogers St
Bloomington, IN 47403-2353
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 # 06697
2701 EAST 3RD ST.
BLOOMINGTON, IN 47401
Pharmacy Comments
Contract Details
Approval Date
10/27/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
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
10/27/2021
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