Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
FQHCLA419A Centerstone Health Services, Inc.

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 # 06739
860 WEST MORGAN STREET
SPENCER, IN 47460

Pharmacy Comments

Contract Details

Approval Date

10/28/2021

Contract Begin Date

1/1/2022

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

10/28/2021

340B Drug Pricing Program Database