Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CH05320AK HealthNet, Inc.

Covered Entity Details

Entity Name

HealthNet, Inc.

Subdivision Name

Wheeler Mission Center for Men Clinic

Type

HRSA-Funded Health Center

340B ID

CH05320AK

Entity Address

215 S Westplex Ave RM 3
Bloomington, IN 47404-5082

Grant Number

H80CS00114

Participating Start Date

7/1/2022

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06697
2701 EAST 3RD ST.
BLOOMINGTON, IN 47401

Pharmacy Comments

Contract Details

Approval Date

10/13/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Varon Edward Cantrell, Chief Medical Officer
(317) 957-2015

Contract Pharmacy Representative

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

Signed By Date

10/13/2023

340B Drug Pricing Program Database