Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
RRC150162-00 FRANCISCAN HEALTH INDIANAPOLIS

Covered Entity Details

Entity Name

FRANCISCAN HEALTH INDIANAPOLIS

Subdivision Name

Type

Rural Referral Center

340B ID

RRC150162-00

Entity Address

8111 S. EMERSON AVENUE
INDIANAPOLIS, IN 46237

Medicare Provider Number

150162

Participating Start Date

4/26/2021

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06610
8405 SOUTHEASTERN AVE.
INDIANAPOLIS, IN 46239

Pharmacy Comments

Contract Details

Approval Date

4/12/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jay Brehm, CFO - Central Indiana
(317) 528-8953

Contract Pharmacy Representative

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

Signed By Date

4/12/2023

340B Drug Pricing Program Database