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HOOK-SUPERX, L.L.C.
DSH150056 INDIANA UNIVERSITY HEALTH INC
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Covered Entity Details
Entity Name
INDIANA UNIVERSITY HEALTH INC
Subdivision Name
Methodist Hospital
Type
Disproportionate Share Hospital
340B ID
DSH150056
Entity Address
1701 N. Senate Blvd
INDIANAPOLIS, IN 46202
Medicare Provider Number
150056
Participating Start Date
4/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01138
11591 OLIO RD.
FISHERS, IN 46037
Pharmacy Comments
Contract Details
Approval Date
7/11/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ryan Kitchell, CFO
(317) 962-2380
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
7/11/2014
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