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HOOK-SUPERX, L.L.C.
CAH181322-00 CALDWELL COUNTY HOSPITAL
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Covered Entity Details
Entity Name
CALDWELL COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181322-00
Entity Address
100 MEDICAL CENTER DRIVE
PRINCETON, KY 42445
Medicare Provider Number
181322
Participating Start Date
10/1/2018
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
CVS/PHARMACY #11114
2800 ENTERPRISE ST STE 5
INDIANAPOLIS, IN 46219-1106
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/11/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Harold Daniel Odegaard, CEO
(270) 365-0321
Contract Pharmacy Representative
CVS Health
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
4/12/2022
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