Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CHC26566-16 JANE PAULEY COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

JANE PAULEY COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Jane Pauley Community Health Center at Shelbyville IN 44

Type

HRSA-Funded Health Center

340B ID

CHC26566-16

Entity Address

1818 E. State Road 44, Suite B
Shelbyville, IN 46176

Grant Number

H80CS26566

Participating Start Date

4/1/2017

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06637
200 S. HARRISON
SHELBYVILLE, IN 46176

Pharmacy Comments

Contract Details

Approval Date

1/9/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Dale Marion, 340B Program Manager
(317) 552-0690

Contract Pharmacy Representative

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

Signed By Date

1/9/2024

340B Drug Pricing Program Database