| Contacts | Authorizing Official | Update | Profile Change Request | Kamikawa, Cindy
Senior VP of Operations
North Hawaii Community Hospital
8086914163 | Kamikawa, Cindy
President
North Hawaii Community Hospital
8088814405 | 5/31/2023 6:42 AM |
| Contacts | Authorizing Official | Update | | Kamikawa, Cindy
Senior VP of Operations
8086914163 | Kamikawa, Cindy
Senior VP of Operations
North Hawaii Community Hospital
8086914163 | 10/23/2017 2:42 PM |
| Contacts | Authorizing Official | Update | | Graham, Kenneth
President
8088814400 | Kamikawa, Cindy
Senior VP of Operations
8086914163 | 9/11/2017 3:29 PM |
| Contacts | Authorizing Official | Update | | Hata, Marilyn
VP Finance
9087839393 | Graham, Kenneth
President
8088814400 | 11/17/2015 10:17 AM |
| Contacts | Primary Contact | Update | | Stillman, Dennis
CFO
8088814406 | Carse, Cherrie
Director of Pharmacy
8088814467 | 11/17/2015 10:17 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 10/30/2015 12:00:00 AM | 11/17/2015 10:17 AM |
| Details | State | Update | | Active | Terminated | 11/17/2015 10:17 AM |
| Terminations | Termination Comments | Update | | | Not a valid site-340B drugs never dispensed to this site. | 11/17/2015 10:17 AM |
| Terminations | Termination Date | Update | | | 1/1/2016 12:00:00 AM | 11/17/2015 10:17 AM |
| Terminations | Termination Effective Date | Update | | | 10/30/2015 12:00:00 AM | 11/17/2015 10:17 AM |
| Terminations | Termination Reason | Update | | | Site closure | 11/17/2015 10:17 AM |
| Addresses | Main Address | Insert | | |
67-1119 MAMALAHOA HWY
KAMUELA, HI 96743 | 11/17/2015 10:17 AM |
| Details | Last Recertification Date | Update | | 8/12/2014 12:00:00 AM | 8/12/2015 12:00:00 AM | 8/12/2015 3:16 PM |
| Details | Last Recertification Date | Update | | 9/5/2013 3:20:02 PM | 8/12/2014 12:00:00 AM | 8/12/2014 8:04 AM |
| Contacts | Authorizing Official | Update | | Brown, William W. H.
Vice President
8088814401 | Hata, Marilyn
VP Finance
9087839393 | 7/23/2014 3:02 PM |
| Contacts | Primary Contact | Update | | Carse, Cherrie G.
Pharmacy Director
8088814467 | Stillman, Dennis
CFO
8088814406 | 7/16/2014 9:47 PM |
| Contacts | Authorizing Official | Update | | Paret, Jason
CFO
8088814406 | Brown, William W. H.
Vice President
8088814401 | 2/21/2014 3:09 PM |
| Details | Last Recertification Date | Update | | | 9/5/2013 3:20:02 PM | 9/5/2013 3:20 PM |
| Contacts | Authorizing Official | Update | | ALLEN, WAYNE C.
CFO
8088814406 | Paret, Jason
CFO
8088814406 | 12/21/2011 10:04 AM |
| Contacts | Primary Contact | Insert | | | Carse, Cherrie G.
Pharmacy Director
8088814467 | 12/21/2011 10:04 AM |
| Contacts | Authorizing Official | Insert | | | ALLEN, WAYNE C.
CFO
8088814406 | 9/29/2011 8:21 PM |
| Details | Comments Public | Insert | | | 09/29/11 participating 10/1/10 thru 6/30/11, not participating 7/1/11 thru 9/30/11, reinstatement approved 9/29/11 | 9/29/2011 8:17 PM |
| Details | State | Update | | Terminated | Active | 9/29/2011 5:48 PM |
| Dates | Start Date | Update | | 1/1/2011 12:00:00 AM | 10/1/2011 12:00:00 AM | 9/29/2011 5:48 PM |
| Terminations | Termination Date | Update | | 7/1/2011 12:00:00 AM | | 9/29/2011 5:48 PM |
| Terminations | Termination Reason | Update | | DSH percentage below statutory minimum | | 9/29/2011 5:48 PM |
| Details | State | Update | | Active | Terminated | 6/30/2011 10:17 PM |
| Dates | Start Date | Update | | 10/1/2011 12:00:00 AM | 1/1/2011 12:00:00 AM | 6/30/2011 10:17 PM |
| Terminations | Termination Date | Update | | | 7/1/2011 12:00:00 AM | 6/30/2011 10:17 PM |
| Terminations | Termination Reason | Update | | | DSH percentage below statutory minimum | 6/30/2011 10:17 PM |
| Details | Comments Public | Insert | | | 9/17/2010- RECD. DOC. DEMONSTRATING ELIG. DSH PERCENTAGE | 6/30/2011 10:17 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 11/28/2010 10:30 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 078352 | 11/28/2010 10:30 AM |
| Medicaid Billing | Medicaid: State | Insert | | | HI | 11/28/2010 10:30 AM |
| Details | Last Recertification Date | Insert | | | | 11/28/2010 10:30 AM |
| Details | Grant Number | Insert | | | | 11/28/2010 10:30 AM |
| Details | 340B ID | Insert | | | DSH120028A | 11/28/2010 10:30 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 11/28/2010 10:30 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 11/28/2010 10:30 AM |
| Details | Medicare Provider Number | Insert | | | 120028 | 11/28/2010 10:30 AM |
| Details | Entity Name | Insert | | | NORTH HAWAII COMMUNITY HOSPITAL | 11/28/2010 10:30 AM |
| Details | Program Code | Insert | | | DSH | 11/28/2010 10:30 AM |
| Details | Entity Subname | Insert | | | NHCH GENERAL SURGERY CLINIC | 11/28/2010 10:30 AM |
| Dates | Participating Approval Date | Insert | | | 12/2/2010 12:00:00 AM | 11/28/2010 10:30 AM |
| Details | State | Insert | | | Active | 11/28/2010 10:30 AM |
| Dates | Registration Date | Insert | | | 11/28/2010 12:00:00 AM | 11/28/2010 10:30 AM |
| Dates | Signed By Date | Insert | | | 10/1/2010 12:00:00 AM | 11/28/2010 10:30 AM |
| Dates | Start Date | Insert | | | 10/1/2011 12:00:00 AM | 11/28/2010 10:30 AM |
| Terminations | Termination Comments | Insert | | | | 11/28/2010 10:30 AM |
| Terminations | Termination Date | Insert | | | | 11/28/2010 10:30 AM |
| Terminations | Termination Effective Date | Insert | | | | 11/28/2010 10:30 AM |
| Terminations | Termination Reason | Insert | | | | 11/28/2010 10:30 AM |
| Details | Comments Public | Insert | | | 09/29/10,participating 10/01/10 to 7/1/11,reinstated 10/1/11 | 11/28/2010 10:30 AM |