Covered Entity Details

DSH120022A STRAUB CLINIC & HOSPITAL (Active) - information as of 5/2/2025 10:34:01 PM

Main Details

Name

STRAUB CLINIC & HOSPITAL

Subdivision Name

STRAUB CLINIC & HOSPITAL - INTERNAL MED PEARLRIDGE

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH120022A

Medicare Provider Number

120022

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/9/2025

Participating Start Date

4/1/2025

Participating Approval Date

1/29/2025

Last Recertification Date

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

98-151 PALI MOMI ST
STE 142
AIEA, HI 96701-4333

Billing Address

STRAUB CLINIC & HOSPITAL
55 MERCHANT ST, 24TH FLOOR
HONOLULU, HI 96813

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start Date7/1/2021, Termination 1/1/2024, Reinstatement 4/1/2025	01/28/2025

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

STRAUB CLINIC & HOSPITAL
888 S. KING ST
HONOLULU, HI 96813

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH120022A	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - INTERNAL MED PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Active
DSH120022AA	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - ENDOCRINOLOGY KANEOHE - ENDOCRINOLOGY KANEOHE	46-056 KAMEHAMEHA HWY	KANEOHE	HI	Active
DSH120022AB	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - Family Medicine FIC	1100 WARD AVE.	Honolulu	HI	Active
DSH120022AC	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB BENIOFF MEDICAL CENTER - Rheumatology Mililani	95-1249 MEHEULA PKWY	MILILANI	HI	Active
DSH120022AD	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB BENIOFF MEDICAL CENTER - Family Medicine Kaneohe	46-056 KAMEHAMEHA HWY	KANEOHE	HI	Active
DSH120022AE	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - Internal Med FIC	1100 Ward Ave.	Honolulu	HI	Active
DSH120022B	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - FAMILY MEDICINE PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Active
DSH120022C	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - SPORTS MEDICINE PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Active
DSH120022D	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - UROLOGY PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Active
DSH120022E	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - OPHTHALMOLOGY PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Active
DSH120022F	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - DERMATOLOGY PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Active
DSH120022G	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - PEDIATRICS PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Active
DSH120022H	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - OB GYN PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Active
DSH120022J	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - OB GYN HAWAII KAI	7192 KALANIANAOLE HWY	HONOLULU	HI	Active
DSH120022K	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - DERMATOLOGY HAWAII KAI	7192 KALANIANAOLE HWY	HONOLULU	HI	Active
DSH120022L	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - FAMILY MEDICINE HAWAII KAI	7192 KALANIANAOLE HWY	HONOLULU	HI	Active
DSH120022M	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - INTERNAL MED HAWAII KAI	7192 KALANIANAOLE HWY	HONOLULU	HI	Active
DSH120022N	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - PEDIATRICS HAWAII KAI	7192 KALANIANAOLE HWY	HONOLULU	HI	Active
DSH120022P	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - FAMILY MEDICINE KAILUA	602 KAILUA RD	KAILUA	HI	Active
DSH120022Q	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - INTERNAL MED KANEOHE	46-056 KAMEHAMEHA HWY	KANEOHE	HI	Active
DSH120022R	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - PEDIATRICS KANEOHE	46-056 KAMEHAMEHA HWY	KANEOHE	HI	Active
DSH120022S	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - OB GYN KANEOHE	46-056 KAMEHAMEHA HWY	KANEOHE	HI	Active
DSH120022T	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - PEDIATRICS MILILANI	95-1249 MEHEULA PKWY	MILILANI	HI	Active
DSH120022U	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - INTERNAL MED MILILANI	95-1249 MEHEULA PKWY	MILILANI	HI	Active
DSH120022V	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - FAMILY MEDICINE MILILANI	95-1249 MEHEULA PKWY	MILILANI	HI	Active
DSH120022W	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - KING STREET OCCUPATIONAL HEALTH	800 S KING ST	HONOLULU	HI	Terminated
DSH120022X	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - PSYCHIATRY	1100 WARD AVE	HONOLULU	HI	Active
DSH120022Y	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB MEDICAL CENTER - CHEST DISEASES PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Active
DSH120022Z	Child	DSH	STRAUB CLINIC & HOSPITAL	STRAUB MEDICAL CENTER - ONCOLOGY PEARLRIDGE	98-151 PALI MOMI ST	AIEA	HI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Addresses	Billing Address	Insert	Reinstatement		STRAUB CLINIC & HOSPITAL 55 MERCHANT ST, 24TH FLOOR HONOLULU, HI 96813	1/29/2025 8:42 AM
Contacts	Primary Contact	Update	Reinstatement	Tsuha-Scarlett, Dawn Director, 340B Program and Pharmacy Regulatory Compliance Hawaii Pacific Health 8084048382	Magday, Shiela P 340B Program Manager Hawaii Pacific Health 8087741342	1/29/2025 8:42 AM
Details	Last Recertification Date	Update	Reinstatement	8/16/2023 12:24:41 PM		1/29/2025 8:42 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	1/1/2024 12:00:00 AM		1/29/2025 8:42 AM
Dates	Participating Approval Date	Update	Reinstatement	4/26/2021 6:37:20 AM	1/29/2025 8:42:10 AM	1/29/2025 8:42 AM
Details	State	Update	Reinstatement	Terminated	Approved	1/29/2025 8:42 AM
Dates	Registration Date	Update	Reinstatement	4/15/2021 6:42:32 AM	1/9/2025 6:38:30 PM	1/29/2025 8:42 AM
Dates	Signed By Date	Update	Reinstatement	4/15/2021 12:30:48 PM	1/10/2025 12:04:03 PM	1/29/2025 8:42 AM
Dates	Start Date	Update	Reinstatement	7/1/2021 12:00:00 AM	4/1/2025 12:00:00 AM	1/29/2025 8:42 AM
Terminations	Termination Date	Update	Reinstatement	1/1/2024 12:00:00 AM		1/29/2025 8:42 AM
Terminations	Termination Effective Date	Update	Reinstatement	1/1/2024 12:00:00 AM		1/29/2025 8:42 AM
Terminations	Termination Reason	Update	Reinstatement	Change of covered entity type		1/29/2025 8:42 AM
Details	Comments Public	Insert	Reinstatement		Participating Start Date7/1/2021, Termination 1/1/2024, Reinstatement 4/1/2025	1/28/2025 1:56 PM
Details	State	Update		To Be Terminated	Terminated	1/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		1/1/2024 12:00:00 AM	10/25/2023 10:23 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	10/25/2023 10:23 AM
Terminations	Termination Date	Update	Hospital Type Change Request		1/1/2024 12:00:00 AM	10/25/2023 10:23 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		1/1/2024 12:00:00 AM	10/25/2023 10:23 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	10/25/2023 10:23 AM
Addresses	Shipping Address	Insert	Recertification		STRAUB CLINIC & HOSPITAL 888 S. KING ST HONOLULU, HI 96813	8/16/2023 12:24 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 12:38:02 PM	8/16/2023 12:24:41 PM	8/16/2023 12:24 PM
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 11:41:20 AM	8/25/2022 12:38:02 PM	8/25/2022 12:38 PM
Details	Last Recertification Date	Update	Recertification		8/16/2021 11:41:20 AM	8/16/2021 11:41 AM
Details	State	Update		Approved	Active	7/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Stumbaugh, David E VP, Supply Chain Management and Pharmacy Hawaii Pacific Health 8085226946	4/26/2021 6:37 AM
Details	340B ID	Update	New Registration		DSH120022A	4/26/2021 6:37 AM
Details	Entity Subname	Update	New Registration	STRAUB CLINIC & HOSPITAL	STRAUB CLINIC & HOSPITAL - INTERNAL MED PEARLRIDGE	4/26/2021 6:37 AM
Dates	Participating Approval Date	Update	New Registration		4/26/2021 6:37:20 AM	4/26/2021 6:37 AM
Details	State	Update	New Registration	Pending	Approved	4/26/2021 6:37 AM
Dates	Signed By Date	Update	New Registration		4/15/2021 12:30:48 PM	4/26/2021 6:37 AM
Dates	Start Date	Update	New Registration		7/1/2021 12:00:00 AM	4/26/2021 6:37 AM
Addresses	Main Address	Insert	New Registration		98-151 PALI MOMI ST STE 142 AIEA, HI 96701-4333	4/15/2021 6:42 AM
Addresses	Billing Address	Insert	New Registration		STRAUB CLINIC & HOSPITAL 55 MERCHANT ST, 24TH FLOOR HONOLULU, HI 96813	4/15/2021 6:42 AM
Contacts	Primary Contact	Insert	New Registration		Tsuha-Scarlett, Dawn Director, 340B Program and Pharmacy Regulatory Compliance Hawaii Pacific Health 8085226906	4/15/2021 6:42 AM
Contacts	Authorizing Official	Insert	New Registration		Stumbaugh, David E VP, Supply Chain Management and Pharmacy Hawaii Pacific Health 8085226946	4/15/2021 6:42 AM
Details	Assistance Received From Date	Insert	New Registration			4/15/2021 6:42 AM
Details	Assistance Received To Date	Insert	New Registration			4/15/2021 6:42 AM
Details	Last Recertification Date	Insert	New Registration			4/15/2021 6:42 AM
Details	Grant Number	Insert	New Registration			4/15/2021 6:42 AM
Details	340B ID	Insert	New Registration			4/15/2021 6:42 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2021 6:42 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2021 6:42 AM
Details	Medicare Provider Number	Insert	New Registration		120022	4/15/2021 6:42 AM
Details	Entity Name	Insert	New Registration		STRAUB CLINIC & HOSPITAL	4/15/2021 6:42 AM
Details	NOFO Number	Insert	New Registration			4/15/2021 6:42 AM
Details	Program Code	Insert	New Registration		DSH	4/15/2021 6:42 AM
Details	Entity Subname	Insert	New Registration		STRAUB CLINIC & HOSPITAL	4/15/2021 6:42 AM
Dates	Participating Approval Date	Insert	New Registration			4/15/2021 6:42 AM
Details	State	Insert	New Registration		Pending	4/15/2021 6:42 AM
Dates	Registration Date	Insert	New Registration		4/15/2021 6:42:32 AM	4/15/2021 6:42 AM
Dates	Signed By Date	Insert	New Registration			4/15/2021 6:42 AM
Dates	Start Date	Insert	New Registration			4/15/2021 6:42 AM
Terminations	Termination Comments	Insert	New Registration			4/15/2021 6:42 AM
Terminations	Termination Date	Insert	New Registration			4/15/2021 6:42 AM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2021 6:42 AM
Terminations	Termination Reason	Insert	New Registration			4/15/2021 6:42 AM