Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CHC24133-00 MAPLE CITY HEALTH CARE CENTER, INC.

Covered Entity Details

Entity Name

MAPLE CITY HEALTH CARE CENTER, INC.

Subdivision Name

Maple City Health Care Center

Type

HRSA-Funded Health Center

340B ID

CHC24133-00

Entity Address

213 Middlebury Street
Goshen, IN 46528-2956

Grant Number

H80CS24133

Participating Start Date

4/1/2013

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06499
308 S. HUNTINGTON ST.
SYRACUSE, IN 46567

Pharmacy Comments

Contract Details

Approval Date

1/14/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Karen Miller Miller Rush, Director of Finance
(574) 534-0088 Ext: 440

Contract Pharmacy Representative

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

Signed By Date

1/14/2022

340B Drug Pricing Program Database