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HOOK-SUPERX, L.L.C.
FQHCLA361 ADULT AND CHILD HEALTH INC
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Covered Entity Details
Entity Name
ADULT AND CHILD HEALTH INC
Subdivision Name
Adult and Child Health - Irvington
Type
Health Center Program Look-Alike
340B ID
FQHCLA361
Entity Address
5839 E. Washington Street
Indianapolis, IN 46219
Grant Number
LALCS31537
Participating Start Date
4/1/2018
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06608
5026 WEST US 52
NEW PALESTINE, IN 46163
Pharmacy Comments
Contract Details
Approval Date
7/16/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jessica Stembel, Chief Clinical Officer
(317) 494-0739
Contract Pharmacy Representative
Adult and Child Health
Dhvani Derasari, 340B Program Manager
(682) 559-8205
Signed By Date
7/16/2023
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