Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
DSH140093 OSF SACRED HEART MEDICAL CENTER

Covered Entity Details

Entity Name

OSF SACRED HEART MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140093

Entity Address

812 NORTH LOGAN AVENUE
DANVILLE, IL 61832-3752

Medicare Provider Number

140093

Participating Start Date

7/1/2025

Last Recertification Date

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06669
511 THIRD ST.
COVINGTON, IN 47932

Pharmacy Comments

Contract Details

Approval Date

6/20/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/2/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

DEBORAH SCHIMEROWSKI, CHIEF FINANCIAL OFFICER
(217) 477-2737

Contract Pharmacy Representative

CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298

Signed By Date

6/20/2014

340B Drug Pricing Program Database