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HOOK-SUPERX, L.L.C.
CAH151322-00 PERRY COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PERRY COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151322-00
Entity Address
8885 State Road 237
TELL CITY, IN 47586
Medicare Provider Number
151322
Participating Start Date
7/1/2011
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06260
225 12TH ST.
TELL CITY, IN 47586
Pharmacy Comments
Contract Details
Approval Date
7/8/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Stuber, CEO/President
(812) 547-0170
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/8/2016
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