Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CHC29005-00 PORTER STARKE SERVICES INC

Covered Entity Details

Entity Name

PORTER STARKE SERVICES INC

Subdivision Name

Porter Starke Services Inc DBA Marram Health Center

Type

HRSA-Funded Health Center

340B ID

CHC29005-00

Entity Address

3229 Broadway Ste 205
Gary, IN 46409

Grant Number

H80CS29005

Participating Start Date

4/1/2016

Last Recertification Date

1/29/2019

Entity Termination Date

1/1/2020

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06906
107 N. CULLEN ST.
RENSSELAER, IN 47978

Pharmacy Comments

Contract Details

Approval Date

10/13/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/15/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Aileen Wehren, VP Systems Administration
(219) 476-4567

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/13/2017

340B Drug Pricing Program Database