340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HOOK-SUPERX, L.L.C.
SCH140167-00 IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Print
Covered Entity Details
Entity Name
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140167-00
Entity Address
200 E FAIRMAN AVE
WATSEKA, IL 60970-1644
Medicare Provider Number
140167
Participating Start Date
4/1/2014
Last Recertification Date
8/28/2019
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06670
512 E. SEYMOUR ST.
KENTLAND, IN 47951
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
LORI YELENICK, INTERIM CFO
(815) 432-7929
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
7/15/2014
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