Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
DSH180138 Baptist Health Lagrange

Covered Entity Details

Entity Name

Baptist Health Lagrange

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180138

Entity Address

1025 New Moody Lane
La Grange, KY 40031

Medicare Provider Number

180138

Participating Start Date

7/1/2013

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03280
255 OLD CAPITAL PLAZA NW
CORYDON, IN 47112

Pharmacy Comments

Contract Details

Approval Date

3/29/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Clint Kaho, President
(502) 222-3329

Contract Pharmacy Representative

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

Signed By Date

3/29/2023

340B Drug Pricing Program Database