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HOOK-SUPERX, L.L.C.
DSH140093A OSF SACRED HEART MEDICAL CENTER
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Covered Entity Details
Entity Name
OSF SACRED HEART MEDICAL CENTER
Subdivision Name
OSF Cancer Care Center
Type
Disproportionate Share Hospital
340B ID
DSH140093A
Entity Address
806 North Logan Street
Danville, IL 61832
Medicare Provider Number
140093
Outpatient Facility Provider Number
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06669
511 THIRD ST.
COVINGTON, IN 47932
Pharmacy Comments
Contract Details
Approval Date
6/20/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DEBORAH SCHIMEROWSKI, CHIEF FINANCIAL OFFICER
(217) 477-2737
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
6/20/2014
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