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HOOK-SUPERX, L.L.C.
CHC26566-17 Jane Pauley Community Health Center, Inc.
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Covered Entity Details
Entity Name
Jane Pauley Community Health Center, Inc.
Subdivision Name
Jane Pauley Community Health Center at Arlington
Type
HRSA-Funded Health Center
340B ID
CHC26566-17
Entity Address
1315 N Arlington Ave
Indianapolis, IN 46219-3278
Grant Number
H80CS26566
Participating Start Date
10/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04633
1233 NORTH STATE ST.
GREENFIELD, IN 46140
Pharmacy Comments
Contract Details
Approval Date
10/1/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aaron Knapp, Dir of Pharmacy Operations
(812) 632-0917
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/1/2024
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