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HOOK-SUPERX, L.L.C.
CAH151304-00 RUSH MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
RUSH MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151304-00
Entity Address
1300 N. MAIN STREET
RUSHVILLE, IN 46173
Medicare Provider Number
151304
Participating Start Date
8/30/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06645
101 WEST 1ST ST.
RUSHVILLE, IN 46173
Pharmacy Comments
Contract Details
Approval Date
10/7/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRADLEY SMITH, CEO
(765) 932-7513
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
10/7/2016
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