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HOOK-SUPERX, L.L.C.
CAH151330-00 ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151330-00
Entity Address
1100 MERCER AVE
DECATUR, IN 46733-0151
Medicare Provider Number
151330
Participating Start Date
9/14/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06516
1221 WEST MONROE ST.
DECATUR, IN 46733
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JO-ELLEN EIDAM, CEO
(260) 724-2145 Ext: 1400
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
10/16/2014
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