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HOOK-SUPERX, L.L.C.
DSH150089 INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC.
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Covered Entity Details
Entity Name
INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150089
Entity Address
2401 W. UNIVERSITY AVENUE
MUNCIE, IN 47303
Medicare Provider Number
150089
Participating Start Date
1/1/2010
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06643
220 S. MEMORIAL DR.
NEW CASTLE, IN 47362
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori A. Luther, Chief Operating Officer
(765) 751-2795
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
7/15/2014
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