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HOOK-SUPERX, L.L.C.
CH05320AN Health Net, Inc.
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Covered Entity Details
Entity Name
Health Net, Inc.
Subdivision Name
HealthNet Homeless Initiative Program - Bloomington
Type
HRSA-Funded Health Center
340B ID
CH05320AN
Entity Address
822 W 1st St, Ste 5
Bloomington, IN 47403-2382
Grant Number
H80CS00114
Participating Start Date
10/1/2024
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06698
2650 S. WALNUT ST.
BLOOMINGTON, IN 47401
Pharmacy Comments
Contract Details
Approval Date
9/4/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Varon Edward Cantrell, Chief Medical Officer
(317) 957-2015
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
9/4/2024
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