Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
DSH150072 MEMORIAL HOSPITAL LOGANSPORT

Covered Entity Details

Entity Name

MEMORIAL HOSPITAL LOGANSPORT

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150072

Entity Address

1101 MICHIGAN AVENUE
LOGANSPORT, IN 46947

Medicare Provider Number

150072

Participating Start Date

4/1/2023

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06537
850 N. PLYMOUTH RD.
WINAMAC, IN 46996

Pharmacy Comments

Contract Details

Approval Date

4/10/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

SHERRI GEHLHAUSEN, CFO
(574) 753-1502

Contract Pharmacy Representative

cvs
Christian Reid, 340B Program Director
(401) 770-2118

Signed By Date

4/10/2023

340B Drug Pricing Program Database