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HOOK-SUPERX, L.L.C.
CH053092H HEALTHLINC INC
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Covered Entity Details
Entity Name
HEALTHLINC INC
Subdivision Name
HealthLinc Southeast
Type
HRSA-Funded Health Center
340B ID
CH053092H
Entity Address
1708 High St
South Bend, IN 46613-2633
Grant Number
H80CS06662
Participating Start Date
4/1/2019
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08631
4403 W. WESTERN AVE.
SOUTH BEND, IN 46619
Pharmacy Comments
Contract Details
Approval Date
4/8/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melissa D Mitchell, CEO
(219) 465-9503
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/8/2024
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