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HOOK-SUPERX, L.L.C.
CH05311W INDIANA HEALTH CENTERS INCORPORATED
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Covered Entity Details
Entity Name
INDIANA HEALTH CENTERS INCORPORATED
Subdivision Name
HealthQuest Van
Type
HRSA-Funded Health Center
340B ID
CH05311W
Entity Address
HEALTHQUEST VAN 925 SOUTH
MARION, IN 46952-3849
Grant Number
H80CS00668
Participating Start Date
7/1/2017
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06621
415 W. 3RD ST.
MARION, IN 46952
Pharmacy Comments
Contract Details
Approval Date
1/5/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Nicole Meyer, COO
(317) 576-1335 Ext: 4137
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/5/2024
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