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HOOK-SUPERX, L.L.C.
RRC150042-00 GOOD SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC150042-00
Entity Address
520 S. Seventh St.
VINCENNES, IN 47591
Medicare Provider Number
150042
Participating Start Date
7/1/2022
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06880
1500 HART ST.
VINCENNES, IN 47591
Pharmacy Comments
Contract Details
Approval Date
4/7/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew S Schuckman, CFO
(812) 885-3334
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/7/2023
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