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HOOK-SUPERX, L.L.C.
CHC08776-01 Valley Professionals Community Health Center, Inc.
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Covered Entity Details
Entity Name
Valley Professionals Community Health Center, Inc.
Subdivision Name
Cayuga Clinic
Type
HRSA-Funded Health Center
340B ID
CHC08776-01
Entity Address
114 North Division Street
Cayuga, IN 47928
Grant Number
H80CS08776
Participating Start Date
10/1/2011
Last Recertification Date
3/1/2016
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06688
820 WEST OHIO STREET
ROCKVILLE, IN 47872
Pharmacy Comments
Contract Details
Approval Date
7/15/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
TERRY J. WARREN JR., CEO
(765) 828-1003
Contract Pharmacy Representative
Eric J, Senior Advisor, Hospital Payer Relations
(877) 204-9323
Signed By Date
7/15/2015
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