Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
FQHCLA392C Edgewater Systems For Balanced Living, Inc.

Covered Entity Details

Entity Name

Edgewater Systems For Balanced Living, Inc.

Subdivision Name

Primary Care

Type

Health Center Program Look-Alike

340B ID

FQHCLA392C

Entity Address

3535 Broadway
Gary, IN 46409-1316

Grant Number

LALCS33108

Participating Start Date

10/1/2019

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06912
11115 WEST 133RD STREET
CEDAR LAKE, IN 46303

Pharmacy Comments

Contract Details

Approval Date

4/1/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Danita A Johnson, CEO
(219) 806-3556

Contract Pharmacy Representative

WellPartner
Anthony McEeachern, Anthony McEachern
(315) 314-1802

Signed By Date

4/1/2024

340B Drug Pricing Program Database