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HOOK-SUPERX, L.L.C.
CHC33650-06 SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
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Covered Entity Details
Entity Name
SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
Subdivision Name
SICHC Mitchell
Type
HRSA-Funded Health Center
340B ID
CHC33650-06
Entity Address
2759 IN-37
Mitchell, IN 47446-6016
Grant Number
H80CS33650
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06714
8830 STATE ROAD 60 WEST
MITCHELL, IN 47446
Pharmacy Comments
Contract Details
Approval Date
7/19/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nancy Radcliff, CEO
(812) 723-3944
Contract Pharmacy Representative
CVS
Courtney Walden, Senior Account Manager
(551) 502-3499
Signed By Date
7/19/2024
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