Covered Entity Details

CH09099W WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED (Approved) - information as of 5/1/2025 11:53:35 PM

Main Details

Name

WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED

Subdivision Name

Mobile Clinic #2

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039335

340B ID

CH09099W

Grant Number

H80CS00807

Additional Details

Current Program Status

Approved

Registration Date

4/2/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/3/2025

Last Recertification Date

Contacts

Authorizing Official

Waianae District Comprehensive Health and Hospital Board, Incorporated
RICHARD BETTINI, President & CEO
(808) 697-3300

Primary Contact

Waianae District Comprehensive Health & Hospital Board, Incorporated
Andrea Baltazar, 340B Program Specialist
(808) 697-3438

Addresses

Street Address

86-260 Farrington Hwy
Waianae, HI 96792-3128

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH090990	Active	BPS-H80-002044	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	WAIANAE COAST COMPREHENSIVE HEALTH CTR	86-260 Farrington Hwy		Waianae	HI
CH09099A	Active	BPS-H80-001879	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Waipahu Family Health Center	94-428 Mokuola St STE 108B		Waipahu	HI
CH09099B	Active	BPS-H80-004284	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	LEEWARD PEDIATRICS	87-2070 Farrington Hwy		Waianae	HI
CH09099C	Active	BPS-H80-000125	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	WAIOLA CLINIC	86-120 FARRINGTON HWY	Ste C305A	WAIANAE	HI
CH09099D	Active	BPS-H80-009450	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	West O'ahu Community Health	599 Farrington Highway BLDG 1 Unit100		Kapolei	HI
CH09099E	Active	BPS-H80-003927	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	MALAMA RECOVERY SERVICES	89-188 Farrington Hwy		Waianae	HI
CH09099F	Active	BPS-H80-007278	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	MOBILE SERVICE VAN	86-260 Farrington Hwy		Waianae	HI
CH09099G	Active	BPS-H80-013815	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Kamaile Olakino Maika'i Health Center	85-180 Ala Akau St		Waianae	HI
CH09099H	Active	BPS-H80-012257	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	West O'ahu Community Health	599 Farrington Highway BLDG 1 - 208		Kapolei	HI
CH09099J	Active	BPS-H80-016815	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Waianae Vision Care	86-120 Farrington Hwy Ste C301		Waianae	HI
CH09099K	Active	BPS-H80-015763	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Waianae High School School-based Health Center	85-251 FARRINGTON HWY		WAIANAE	HI
CH09099L	Active	BPS-H80-015755	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Waianae Intermediate School School-based Health Center	85-626 FARRINGTON HWY		WAIANAE	HI
CH09099M	Active	BPS-H80-021708	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Ewa - West O`ahu Community Health Center	91-1841 Ft. Weaver Rd.		Ewa Beach	HI
CH09099N	Active	BPS-H80-021663	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Nanakuli High & Intermediate School	89-980 Nanakuli Avenue		Waianae	HI
CH09099P	Active	BPS-H80-029453	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Waipahu Family Health Center	94-428 Mokuola St. STE 213		Waipahu	HI
CH09099Q	Active	BPS-H80-031716	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	The Comp at Tamura Super Market	86-032 Farrington Hwy Ste 101		Waianae	HI
CH09099R	Active	BPS-H80-032121	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	James and Abigail Campbell Clinic	89-102 Farrington Hwy	Unit 3000	Waianae	HI
CH09099S	Active	BPS-H80-036841	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Nanaikapono Elementary School	89-153 Mano Ave		Waianae	HI
CH09099T	Active	BPS-H80-037312	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Mobile Clinic	86-260 Farrington Hwy		Waianae	HI
CH09099U	Active	BPS-H80-036874	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Waianae Elementary School	85-220 McArthur St		Waianae	HI
CH09099V	Approved	BPS-H80-038878	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Makaha Health	84-225 Ala Naauau St		Waianae	HI
CH09099W	Approved	BPS-H80-039335	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Mobile Clinic #2	86-260 Farrington Hwy		Waianae	HI
CH09099X	Approved	BPS-H80-039731	WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	Dental Mobile Clinic Van #3	86-260 Farrington Hwy		Waianae	HI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 04728	1130 KUALA ST.	PEARL CITY	HI	96782	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 17471	4450 KAPOLEI PKWY	KAPOLEI	HI	96707	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA LONGS DRUGS #7356	91-919 FT WEAVER RD., SPACE 106	EWA BEACH	HI	96706	07/01/2023	09/10/2024
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09275	850 KAMEHAMEHA HWY STE 107	PEARL CITY	HI	96782	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09317	590 FARRINGTON HWY UNIT 300	KAPOLEI	HI	96707	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09300	925 CALIFORNIA AVE	WAHIAWA	HI	96786	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA CVS/PHARMACY #7107	89-102 FARRINGTON HWY, UNIT 4	WAIANAE	HI	96792	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 10988	84-1160 FARRINGTON HWY	WAIANAE	HI	96792	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09988	91 1401 FORT WEAVER RD	EWA BEACH	HI	96706	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09259	94-060 FARRINGTON HWY #6	WAIPAHU	HI	96797	07/01/2023
CH090990	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09813	98 1005 MOANALUA RD #400	AIEA	HI	96701	07/01/2023
CH09099A	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09259	94-060 FARRINGTON HWY #6	WAIPAHU	HI	96797	10/01/2024
CH09099H	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09259	94-060 FARRINGTON HWY #6	WAIPAHU	HI	96797	10/01/2024
CH09099P	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09259	94-060 FARRINGTON HWY #6	WAIPAHU	HI	96797	10/01/2024
CH09099C	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099S	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099K	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099P	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA LONGS DRUGS #7356	91-919 FT WEAVER RD., SPACE 106	EWA BEACH	HI	96706	10/01/2024
CH09099D	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09317	590 FARRINGTON HWY UNIT 300	KAPOLEI	HI	96707	10/01/2024
CH09099N	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA CVS/PHARMACY #7107	89-102 FARRINGTON HWY, UNIT 4	WAIANAE	HI	96792	10/01/2024
CH09099A	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA LONGS DRUGS #7356	91-919 FT WEAVER RD., SPACE 106	EWA BEACH	HI	96706	10/01/2024
CH09099E	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA CVS/PHARMACY #7107	89-102 FARRINGTON HWY, UNIT 4	WAIANAE	HI	96792	10/01/2024
CH09099J	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099H	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09317	590 FARRINGTON HWY UNIT 300	KAPOLEI	HI	96707	10/01/2024
CH09099Q	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 10988	84-1160 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099U	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 10988	84-1160 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099R	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099T	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099R	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA CVS/PHARMACY #7107	89-102 FARRINGTON HWY, UNIT 4	WAIANAE	HI	96792	10/01/2024
CH09099Q	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099G	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 10988	84-1160 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099L	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099M	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09988	91 1401 FORT WEAVER RD	EWA BEACH	HI	96706	10/01/2024
CH09099F	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099E	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099J	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 10988	84-1160 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099T	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA CVS/PHARMACY #7107	89-102 FARRINGTON HWY, UNIT 4	WAIANAE	HI	96792	10/01/2024
CH09099U	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099K	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 10988	84-1160 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099C	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 10988	84-1160 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099F	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA CVS/PHARMACY #7107	89-102 FARRINGTON HWY, UNIT 4	WAIANAE	HI	96792	10/01/2024
CH09099D	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09259	94-060 FARRINGTON HWY #6	WAIPAHU	HI	96797	10/01/2024
CH09099N	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09956	86 120 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099S	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA CVS/PHARMACY #7107	89-102 FARRINGTON HWY, UNIT 4	WAIANAE	HI	96792	10/01/2024
CH09099M	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA LONGS DRUGS #7356	91-919 FT WEAVER RD., SPACE 106	EWA BEACH	HI	96706	10/01/2024
CH09099L	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 10988	84-1160 FARRINGTON HWY	WAIANAE	HI	96792	10/01/2024
CH09099P	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09813	98 1005 MOANALUA RD #400	AIEA	HI	96701	01/01/2025
CH09099E	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09300	925 CALIFORNIA AVE	WAHIAWA	HI	96786	01/01/2025
CH09099L	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09988	91 1401 FORT WEAVER RD	EWA BEACH	HI	96706	01/01/2025
CH09099H	LONGS DRUG STORES CALIFORNIA, L.L.C.	LONGS DRUGS # 17471	4450 KAPOLEI PKWY	KAPOLEI	HI	96707	01/01/2025
CH09099G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 09275	850 KAMEHAMEHA HWY STE 107	PEARL CITY	HI	96782	01/01/2025
CH09099M	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: LONGS DRUGS # 04728	1130 KUALA ST.	PEARL CITY	HI	96782	01/01/2025
CH090990	VALUE DRUG LTD. DBA PHARMACARE	3375 KOAPAKA ST STE G320		HONOLULU	HI	96819-1898	01/01/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		BETTINI, RICHARD President & CEO Waianae District Comprehensive Health and Hospital Board, Incorporated 8086973300	4/3/2025 9:12 AM
Details	340B ID	Update	New Registration		CH09099W	4/3/2025 9:12 AM
Dates	Participating Approval Date	Update	New Registration		4/3/2025 9:12:40 AM	4/3/2025 9:12 AM
Details	State	Update	New Registration	Pending	Approved	4/3/2025 9:12 AM
Dates	Signed By Date	Update	New Registration		4/2/2025 5:52:15 PM	4/3/2025 9:12 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/3/2025 9:12 AM
Addresses	Main Address	Insert	New Registration		86-260 Farrington Hwy Waianae, HI 96792-3128	4/2/2025 3:50 PM
Contacts	Authorizing Official	Insert	New Registration		BETTINI, RICHARD President & CEO Waianae District Comprehensive Health and Hospital Board, Incorporated 8086973300	4/2/2025 3:50 PM
Contacts	Primary Contact	Insert	New Registration		Baltazar, Andrea 340B Program Specialist Waianae District Comprehensive Health & Hospital Board, Incorporated 8086973438	4/2/2025 3:50 PM
Details	Assistance Received From Date	Insert	New Registration			4/2/2025 3:50 PM
Details	Assistance Received To Date	Insert	New Registration			4/2/2025 3:50 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2025 3:50 PM
Details	Grant Number	Insert	New Registration		H80CS00807	4/2/2025 3:50 PM
Details	340B ID	Insert	New Registration			4/2/2025 3:50 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2025 3:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2025 3:50 PM
Details	Medicare Provider Number	Insert	New Registration			4/2/2025 3:50 PM
Details	Entity Name	Insert	New Registration		WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED	4/2/2025 3:50 PM
Details	NOFO Number	Insert	New Registration			4/2/2025 3:50 PM
Details	Program Code	Insert	New Registration		CH	4/2/2025 3:50 PM
Details	Entity Subname	Insert	New Registration		Mobile Clinic #2	4/2/2025 3:50 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2025 3:50 PM
Details	State	Insert	New Registration		Pending	4/2/2025 3:50 PM
Dates	Registration Date	Insert	New Registration		4/2/2025 3:50:39 PM	4/2/2025 3:50 PM
Dates	Signed By Date	Insert	New Registration			4/2/2025 3:50 PM
Dates	Start Date	Insert	New Registration			4/2/2025 3:50 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2025 3:50 PM
Terminations	Termination Date	Insert	New Registration			4/2/2025 3:50 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2025 3:50 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2025 3:50 PM

340B Drug Pricing Program Database