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HOOK-SUPERX, L.L.C.
CHC02456-00 WINDROSE HEALTH NETWORK, INC.
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Covered Entity Details
Entity Name
WINDROSE HEALTH NETWORK, INC.
Subdivision Name
Windrose Health Network - Trafalgar
Type
HRSA-Funded Health Center
340B ID
CHC02456-00
Entity Address
14 Trafalgar Sq
Trafalgar, IN 46181-9515
Grant Number
H80CS02456
Participating Start Date
10/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HOOK-SUPERX, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00684
7930 MADISON AVE.
INDIANAPOLIS, IN 46227
Pharmacy Comments
Contract Details
Approval Date
7/28/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott K Rollett, CEO
(317) 739-4895 Ext: 2401
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
7/28/2016
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