Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
DSH150091 HUNTINGTON MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

HUNTINGTON MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150091

Entity Address

2001 STULTS ROAD
HUNTINGTON, IN 46750

Medicare Provider Number

150091

Participating Start Date

7/1/2022

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06517
1901 N. JEFFERSON ST.
HUNTINGTON, IN 46750

Pharmacy Comments

Contract Details

Approval Date

4/15/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2015

Contacts

Covered Entity Signing Official

Michael P. Browning, Senior Vice President and Chief Financial Officer
(260) 373-8407

Contract Pharmacy Representative

John R. Zevzavadjian, Vice President, Managed Care
(401) 770-5503

Signed By Date

4/15/2013

340B Drug Pricing Program Database