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HOOK-SUPERX, L.L.C.
CH053110 INDIANA HEALTH CENTERS INCORPORATED
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Covered Entity Details
Entity Name
INDIANA HEALTH CENTERS INCORPORATED
Subdivision Name
INDIANA HEALTH CENTERS, INC.
Type
HRSA-Funded Health Center
340B ID
CH053110
Entity Address
8003 Castleway Dr
Indianapolis, IN 46250-1946
Grant Number
H80CS00668
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06534
717 NORTH 3RD STREET
LOGANSPORT, IN 46947
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nicole Meyer, COO
(317) 576-1335 Ext: 4137
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2022
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