Covered Entity Details

PED123300-00 KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN (Active) - information as of 6/6/2025 12:35:10 PM

Main Details

Name

KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN

Subdivision Name

Type

Children's Hospital

Rural

340B ID

PED123300-00

Medicare Provider Number

123300

Additional Details

Current Program Status

Active

Registration Date

8/6/2010

Participating Start Date

8/6/2010

Participating Approval Date

8/6/2010

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Hawaii Pacific Health
David E Stumbaugh, VP, Supply Chain Management and Pharmacy
(808) 522-6946

Primary Contact

Hawaii Pacific Health
Shiela P Magday, 340B Program Manager
(808) 774-1342

Addresses

Street Address

1319 PUNAHOU STREET
HONOLULU, HI 96826

Billing Address

Kapiolani Medical Center for Women & Children
55 Merchant Street, 24th Floor
Honolulu, HI 96813

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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

Shipping Address 1

Kapiolani Medical Center for Women and Children
1319 Punahou Street
Honolulu, HI 96826

Shipping Address 2

Kapiolani Medical Center Outpatient Pharmacy
1319 Punahou Street Tower Suite 100
Honolulu, HI 96826

Shipping Address 3

Hawaii Cellular Therapy and Transplant Laboratory
800 South Beretania Street, Suite 340
Honolulu, HI 96813

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/15/2019	01/01/2020		01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/15/2019	01/01/2020		01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/15/2019	01/01/2020		01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	2410 WARDLOW RD	STE 101	CORONA	CA	92878	04/11/2025	07/01/2025		04/11/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/15/2019	01/01/2020		01/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	11411 STRANG LINE RD	STE A	LENEXA	KS	66215	10/15/2019	01/01/2020		01/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	677 ALA MOANA BLVD STE 404		HONOLULU	HI	96813-5412	10/15/2019	01/01/2020		01/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/11/2025	07/01/2025		04/11/2025
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/14/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/14/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/14/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/14/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/14/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/14/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/14/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/14/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/14/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/14/2019	04/01/2019		04/01/2019
Contract Detail	HAWAII PACIFIC HEALTH SPECIALTY PHARMACY	3375 KOAPAKA STREET	STE H400	HONOLULU	HI	96819	04/07/2023	07/01/2023		07/01/2023
Contract Detail	PHARMACARE NO. 6	1319 PUNAHOU ST	TOWER SUITE 100	HONOLULU	HI	96826-1001	01/11/2019	04/01/2019	11/21/2022	01/30/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/14/2019	04/01/2019		04/01/2019
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/14/2019	04/01/2019		04/01/2019
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/14/2019	04/01/2019		04/01/2019
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #2944	1234 S BERETANIA STREET	HONOLULU	HI	96814	01/11/2019	04/01/2019	12/04/2019	12/20/2019
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1087	200 HAMAKUA DRIVE	KAILUA	HI	96734	01/11/2019	04/01/2019	12/04/2019	12/20/2019
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/11/2019	04/01/2019	01/01/2020	01/01/2020
Contract Detail	WAL-MART PHARMACY 10-2314	94-595 KUPUOHI STREET		WAIPAHU	HI	96797	01/11/2019	04/01/2019	01/01/2020	01/01/2020
Contract Detail	WAL-MART PHARMACY 10-3478	700 KEEAUMOKU STREET		HONOLULU (C)	HI	96814	01/11/2019	04/01/2019	01/01/2020	01/01/2020
Contract Detail	WAL-MART PHARMACY 10-5274	1131 KUALA ST.		PEARL CITY	HI	96782	01/11/2019	04/01/2019	01/01/2020	01/01/2020
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/11/2019	04/01/2019	01/01/2020	01/01/2020

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/24/2023 11:21:09 AM	8/21/2024 5:59:48 PM	8/21/2024 5:59 PM
Contacts	Primary Contact	Update	Profile Change Request	Magday, Shiela Pioquinto 340B Program Manager Hawaii Pacific Health 8087741342	Magday, Shiela P 340B Program Manager Hawaii Pacific Health 8087741342	8/13/2024 3:08 PM
Contacts	Primary Contact	Update	PC Change Request	Tsuha-Scarlett, Dawn Director, 340B Program and Pharmacy Regulatory Compliance Hawaii Pacific Health 8084048382	Magday, Shiela Pioquinto 340B Program Manager Hawaii Pacific Health 8087741342	12/13/2023 8:06 AM
Details	Last Recertification Date	Update	Recertification	9/19/2022 7:54:12 AM	8/24/2023 11:21:09 AM	8/24/2023 11:21 AM
Addresses	Shipping Address	Insert	Change Request		Hawaii Cellular Therapy and Transplant Laboratory 800 South Beretania Street, Suite 340 Honolulu, HI 96813	3/9/2023 7:18 AM
Addresses	Shipping Address	Insert	Change Request		Kapiolani Medical Center for Women and Children 1319 Punahou Street Honolulu, HI 96826	11/17/2022 11:06 AM
Addresses	Shipping Address	Insert	Change Request		Kapiolani Medical Center Outpatient Pharmacy 1319 Punahou Street Tower Suite 100 Honolulu, HI 96826	11/17/2022 11:06 AM
Contacts	Primary Contact	Update	Profile Change Request	Tsuha-Scarlett, Dawn Director, 340B Program and Pharmacy Regulatory Compliance Hawaii Pacific Health 8085226906	Tsuha-Scarlett, Dawn Director, 340B Program and Pharmacy Regulatory Compliance Hawaii Pacific Health 8084048382	10/14/2022 12:40 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 11:38:35 AM	9/19/2022 7:54:12 AM	9/19/2022 7:54 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 10:53:32 AM	8/16/2021 11:38:35 AM	8/16/2021 11:38 AM
Contacts	Authorizing Official	Update	Change Request	SMITH, MARTHA Executive Vice President, Oahu Operations Hawaii Pacific Health 8085222520	Stumbaugh, David E VP, Supply Chain Management and Pharmacy Hawaii Pacific Health 8085226946	3/11/2021 6:46 AM
Details	Last Recertification Date	Update	Recertification	9/8/2019 10:13:50 AM	9/10/2020 10:53:32 AM	9/10/2020 10:53 AM
Contacts	Primary Contact	Update	Change Request	Tsuha-Scarlett, Dawn Director, Pharmacy Hawaii Pacific Health 8085226906	Tsuha-Scarlett, Dawn Director, 340B Program and Pharmacy Regulatory Compliance Hawaii Pacific Health 8085226906	1/31/2020 8:33 AM
Contacts	Authorizing Official	Update	Profile Change Request	SMITH, MARTHA CEO Kapiolani Medical Center for Women and Children 8089838071	SMITH, MARTHA Executive Vice President, Oahu Operations Hawaii Pacific Health 8085222520	1/30/2020 12:32 PM
Details	Last Recertification Date	Update	Recertification	8/29/2018 4:04:19 PM	9/8/2019 10:13:50 AM	9/8/2019 10:13 AM
Addresses	Billing Address	Insert	Change Request		Kapiolani Medical Center for Women & Children 55 Merchant Street, 24th Floor Honolulu, HI 96813	11/12/2018 12:13 PM
Details	Last Recertification Date	Update	Recertification	11/16/2017 12:25:01 PM	8/29/2018 4:04:19 PM	8/29/2018 4:04 PM
Contacts	Primary Contact	Update	Profile Change Request	Tsuha-Scarlett, Dawn Director, Pharmacy Kapiolani Medical Center for Women & Children 8089838132	Tsuha-Scarlett, Dawn Director, Pharmacy Hawaii Pacific Health 8085226906	8/15/2018 1:57 PM
Contacts	Primary Contact	Update	Change Request	TSUHA-SCARLETT, DAWN DIRECTOR, PHARMACY Kapiolani Medical Center for Women and Children 8089838132	Tsuha-Scarlett, Dawn Director, Pharmacy Kapiolani Medical Center for Women & Children 8089838132	1/15/2018 11:51 AM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	11/16/2017 12:25:01 PM	11/16/2017 12:25 PM
Contacts	Primary Contact	Update	Recertification	TSUHA-SCARLETT, DAWN DIRECTOR, PHARMACY 8089838132	TSUHA-SCARLETT, DAWN DIRECTOR, PHARMACY Kapiolani Medical Center for Women and Children 8089838132	11/13/2017 4:28 PM
Contacts	Authorizing Official	Update		SMITH, MARTHA CEO 8089838071	SMITH, MARTHA CEO Kapiolani Medical Center for Women and Children 8089838071	10/26/2017 1:33 PM
Addresses	Main Address	Insert			1319 PUNAHOU STREET HONOLULU, HI 96826	6/20/2017 8:52 PM
Contacts	Authorizing Official	Insert			SMITH, MARTHA CEO 8089838071	6/20/2017 8:52 PM
Contacts	Primary Contact	Insert			TSUHA-SCARLETT, DAWN DIRECTOR, PHARMACY 8089838132	6/20/2017 8:52 PM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 10:54 PM
Details	Last Recertification Date	Update		8/22/2014 12:00:00 AM	8/12/2015 12:00:00 AM	8/12/2015 1:29 PM
Details	Last Recertification Date	Update		9/9/2013 12:00:00 AM	8/22/2014 12:00:00 AM	8/22/2014 7:54 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/9/2013 12:00:00 AM	9/9/2013 8:41 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	4/23/2012 8:44 AM
Details	Last Recertification Date	Insert				8/6/2010 2:56 PM
Details	Grant Number	Insert				8/6/2010 2:56 PM
Details	340B ID	Insert			PED123300-00	8/6/2010 2:56 PM
Details	Is Authorizing Official EHB Data	Insert				8/6/2010 2:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/6/2010 2:56 PM
Details	Medicare Provider Number	Insert			123300	8/6/2010 2:56 PM
Details	Entity Name	Insert			KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN	8/6/2010 2:56 PM
Details	Program Code	Insert			PED	8/6/2010 2:56 PM
Details	Entity Subname	Insert				8/6/2010 2:56 PM
Dates	Participating Approval Date	Insert			8/6/2010 12:00:00 AM	8/6/2010 2:56 PM
Details	State	Insert			Active	8/6/2010 2:56 PM
Dates	Registration Date	Insert			8/6/2010 12:00:00 AM	8/6/2010 2:56 PM
Dates	Signed By Date	Insert			7/7/2010 12:00:00 AM	8/6/2010 2:56 PM
Dates	Start Date	Insert			8/6/2010 12:00:00 AM	8/6/2010 2:56 PM
Terminations	Termination Comments	Insert				8/6/2010 2:56 PM
Terminations	Termination Date	Insert				8/6/2010 2:56 PM
Terminations	Termination Effective Date	Insert				8/6/2010 2:56 PM
Terminations	Termination Reason	Insert				8/6/2010 2:56 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Parent/Child

History