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HOOK-SUPERX, L.L.C.
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
JANE PAULEY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Jane Pauley Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26566-00
Entity Address
8931 E. 30th Street
Indianapolis, IN 46219-1501
Grant Number
H80CS26566
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY #06622
1700 N. WALNUT ST
HARTFORD CITY, IN 47348
Pharmacy Comments
Contract Details
Approval Date
10/10/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dale Marion, 340B Program Manager
(317) 552-0690
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2022
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