Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
RRC140093-00 OSF SACRED HEART MEDICAL CENTER

Covered Entity Details

Entity Name

OSF SACRED HEART MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

340B ID

RRC140093-00

Entity Address

812 NORTH LOGAN AVENUE
DANVILLE, IL 61832

Medicare Provider Number

140093

Participating Start Date

7/1/2024

Last Recertification Date

9/3/2024

Entity Termination Date

7/1/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06669
511 THIRD ST.
COVINGTON, IN 47932

Pharmacy Comments

Contract Details

Approval Date

5/6/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Diane L. McGrew, President
(309) 655-2850

Contract Pharmacy Representative

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

Signed By Date

4/15/2024

340B Drug Pricing Program Database