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HOOK-SUPERX L.L.C.
CH05320J HealthNet, Inc.
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Covered Entity Details
Entity Name
HealthNet, Inc.
Subdivision Name
Speedway Health & Dental Center
Type
HRSA-Funded Health Center
340B ID
CH05320J
Entity Address
6020 Crawfordsville Rd
Ste 102
Indianapolis, IN 46224
Grant Number
H80CS00114
Participating Start Date
4/1/2013
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06553
2320 CUNNINGHAM RD.
INDIANAPOLIS, IN 46224
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
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