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HOOK-SUPERX, L.L.C.
DSH150097 MAJOR HOSPITAL
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Covered Entity Details
Entity Name
MAJOR HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150097
Entity Address
2451 INTELLIPLEX DR
SHELBYVILLE, IN 46176
Medicare Provider Number
150097
Participating Start Date
7/1/2022
Last Recertification Date
8/20/2024
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
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ralph N Mercuri, CFO
(317) 398-5254
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
7/8/2024
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