Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
DSH370091 Saint Francis Hospital

Covered Entity Details

Entity Name

Saint Francis Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370091

Entity Address

6161 South Yale Avenue
Tulsa, OK 74136

Medicare Provider Number

370091

Participating Start Date

4/1/2012

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

CVS/PHARMACY #11114
2800 ENTERPRISE ST STE 5
INDIANAPOLIS, IN 46219-1106

Pharmacy Comments

Contract Details

Approval Date

4/14/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/15/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Deborah D Dage, SRVP/Chief Financial Officer
(918) 494-8418

Contract Pharmacy Representative

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

Signed By Date

4/14/2023

340B Drug Pricing Program Database