340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HOOK-SUPERX, L.L.C.
CAH151323-00 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.
Print
Covered Entity Details
Entity Name
COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151323-00
Entity Address
207 NORTH TOWNLINE ROAD
LAGRANGE, IN 46761
Medicare Provider Number
151323
Participating Start Date
4/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06509
2802 EAST STATE BOULEVARD
FORT WAYNE, IN 46805
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/10/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stanton Risser, Assoc Chief Financial Officer
(260) 266-9313
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
10/15/2015
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session