Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
RWI11432 AIDS Center of Queens County, Inc.

Covered Entity Details

Entity Name

AIDS Center of Queens County, Inc.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI11432

Entity Address

161-21 Jamaica Avenue, 6th Floor
Jamaica, NY 11432-6113

Grant Number

H89HA00015

Participating Start Date

10/1/2013

Last Recertification Date

2/24/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06463
2210 E. EDISON
SOUTH BEND, IN 46615

Pharmacy Comments

06/27/2012 changed address (was 2210 East Edison Rd.)

Contract Details

Approval Date

10/10/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022

Contract Pharmacy Representative

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

Signed By Date

10/10/2022

340B Drug Pricing Program Database