Covered Entity Details

CH09229A WAIMANALO HEALTH CENTER (Active) - information as of 6/12/2025 6:06:57 AM

Main Details

Name

WAIMANALO HEALTH CENTER

Subdivision Name

Waimanalo Health Center - Hale Ola `Alua

Type

HRSA-Funded Health Center

Site ID

BPS-H80-027251

340B ID

CH09229A

Grant Number

H80CS00646

Additional Details

Current Program Status

Active

Registration Date

7/12/2019

Participating Start Date

10/1/2019

Participating Approval Date

8/5/2019

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Waimanalo Health Center
MARY ONEHA, CEO
(808) 954-7107

Primary Contact

Waimanalo Health Center
Patricia L Sutton, COO
(808) 954-7103

Addresses

Street Address

41-1295 Kalanianaole Hwy
Waimanalo, HI 96795-1247

Billing Address

Waimanalo Health Center
41-1347 Kalanianaole Hwy
Waimanalo, HI 96795

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?
Yes

State	Medicaid Number	NPI Number
HI	049587	1952073397,1134773344

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	City	State
CH092290	Active	BPS-H80-000438	WAIMANALO HEALTH CENTER	WAIMANALO HEALTH CENTER	41-1347 Kalanianaole Hwy	Waimanalo	HI
CH09229A	Active	BPS-H80-027251	WAIMANALO HEALTH CENTER	Waimanalo Health Center - Hale Ola `Alua	41-1295 Kalanianaole Hwy	Waimanalo	HI
CH09229B	Active	BPS-H80-036224	WAIMANALO HEALTH CENTER	Waimanalo Health Center Hale Ola `Akolu-Luluku	45-600 Kamehameha Hwy	Kaneohe	HI
CH09229C	Approved	BPS-H80-039503	WAIMANALO HEALTH CENTER	Waimanalo Elementary and Intermediate School	41-1330 Kalanianaole Hwy	Waimanalo	HI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Carve-In Effective Date	Termination Date
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 3:25:54 PM	2/10/2025 4:10:09 PM	2/10/2025 4:10 PM
Details	Last Recertification Date	Update	Recertification	1/30/2023 4:49:33 PM	1/29/2024 3:25:54 PM	1/29/2024 3:25 PM
Contacts	Primary Contact	Update	Change Request	Ziegler, Leigh Clinical Director Waimanalo Health Center 8089547104-8089547107	Sutton, Patricia L COO Waimanalo Health Center 8089547103	9/5/2023 10:22 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	4958701 (HI)		3/23/2023 5:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/23/2023 5:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		049587	3/23/2023 5:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		HI	3/23/2023 5:35 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1952073397	3/23/2023 5:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		HI	3/23/2023 5:35 PM
Details	Last Recertification Date	Update	Recertification	2/1/2022 4:26:12 PM	1/30/2023 4:49:33 PM	1/30/2023 4:49 PM
Details	Last Recertification Date	Update	Recertification	2/5/2021 5:27:49 PM	2/1/2022 4:26:12 PM	2/1/2022 4:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/5/2021 5:27 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4958701	2/5/2021 5:27 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		HI	2/5/2021 5:27 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1134773344 ( )		2/5/2021 5:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134773344	2/5/2021 5:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	2/5/2021 5:27 PM
Details	Last Recertification Date	Update	Recertification	1/27/2020 10:10:24 PM	2/5/2021 5:27:49 PM	2/5/2021 5:27 PM
Details	Last Recertification Date	Update	Recertification		1/27/2020 10:10:24 PM	1/27/2020 10:10 PM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1134773344	8/14/2019 5:30 PM
Contacts	Signed By	Insert	New Registration		ONEHA, MARY CEO Waimanalo Health Center 8089547107	8/5/2019 12:55 PM
Details	340B ID	Update	New Registration		CH09229A	8/5/2019 12:55 PM
Dates	Participating Approval Date	Update	New Registration		8/5/2019 12:55:13 PM	8/5/2019 12:55 PM
Details	State	Update	New Registration	Pending	Approved	8/5/2019 12:55 PM
Dates	Signed By Date	Update	New Registration		7/12/2019 4:40:48 PM	8/5/2019 12:55 PM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	8/5/2019 12:55 PM
Addresses	Main Address	Insert	New Registration		41-1295 Kalanianaole Hwy Waimanalo, HI 96795-1247	7/12/2019 4:40 PM
Addresses	Billing Address	Insert	New Registration		Waimanalo Health Center 41-1347 Kalanianaole Hwy Waimanalo, HI 96795	7/12/2019 4:40 PM
Contacts	Authorizing Official	Insert	New Registration		ONEHA, MARY CEO Waimanalo Health Center 8089547107	7/12/2019 4:40 PM
Contacts	Primary Contact	Insert	New Registration		Ziegler, Leigh Clinical Director Waimanalo Health Center 8089547104-8089547107	7/12/2019 4:40 PM
Details	Last Recertification Date	Insert	New Registration			7/12/2019 4:40 PM
Details	Grant Number	Insert	New Registration		H80CS00646	7/12/2019 4:40 PM
Details	340B ID	Insert	New Registration			7/12/2019 4:40 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/12/2019 4:40 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/12/2019 4:40 PM
Details	Medicare Provider Number	Insert	New Registration			7/12/2019 4:40 PM
Details	Entity Name	Insert	New Registration		WAIMANALO HEALTH CENTER	7/12/2019 4:40 PM
Details	Program Code	Insert	New Registration		CH	7/12/2019 4:40 PM
Details	Entity Subname	Insert	New Registration		Waimanalo Health Center - Hale Ola `Alua	7/12/2019 4:40 PM
Dates	Participating Approval Date	Insert	New Registration			7/12/2019 4:40 PM
Details	State	Insert	New Registration		Pending	7/12/2019 4:40 PM
Dates	Registration Date	Insert	New Registration		7/12/2019 4:40:46 PM	7/12/2019 4:40 PM
Dates	Signed By Date	Insert	New Registration			7/12/2019 4:40 PM
Dates	Start Date	Insert	New Registration			7/12/2019 4:40 PM
Terminations	Termination Comments	Insert	New Registration			7/12/2019 4:40 PM
Terminations	Termination Date	Insert	New Registration			7/12/2019 4:40 PM
Terminations	Termination Effective Date	Insert	New Registration			7/12/2019 4:40 PM
Terminations	Termination Reason	Insert	New Registration			7/12/2019 4:40 PM

340B Drug Pricing Program Database