Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
DSH150109 FRANCISCAN HEALTH LAFAYETTE

Covered Entity Details

Entity Name

FRANCISCAN HEALTH LAFAYETTE

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150109

Entity Address

1701 SOUTH CREASY LANE
LAFAYETTE, IN 47905

Medicare Provider Number

150109

Participating Start Date

4/26/2021

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06668
106 EAST MARKET STREET
CRAWFORDSVILLE, IN 47933

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

Jason Geddes, Regional CFO
(765) 502-4599

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