Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CH05320AR Health Net, Inc.

Covered Entity Details

Entity Name

Health Net, Inc.

Subdivision Name

Monroe County Public Library Clinic

Type

HRSA-Funded Health Center

340B ID

CH05320AR

Entity Address

303 East Kirkwood Ave, Room 2B
Bloomington, IN 47408-3534

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 # 08665
3910 W. 3RD ST.
BLOOMINGTON, IN 47404

Pharmacy Comments

Contract Details

Approval Date

9/11/2024

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

340B Drug Pricing Program Database