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HOOK-SUPERX, L.L.C.
FQHCLA392 Edgewater Systems For Balanced Living, Inc.
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Covered Entity Details
Entity Name
Edgewater Systems For Balanced Living, Inc.
Subdivision Name
Primary Care - Griffith
Type
Health Center Program Look-Alike
340B ID
FQHCLA392
Entity Address
1212 N Broad St
Griffith, IN 46319-1534
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 # 02542
3405 RIDGE RD
HIGHLAND, IN 46322
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Danita A Johnson, CEO
(219) 806-3556
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/11/2024
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