Covered Entity Details

DSH120001AP THE QUEEN'S MEDICAL CENTER (Active) - information as of 4/30/2025 10:54:54 PM

Main Details

Name

THE QUEEN'S MEDICAL CENTER

Subdivision Name

THE QUEEN'S MEDICAL CENTER - The Queen's Medical Center - West Oahu Urology Services, 3rd Floor

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH120001AP

Medicare Provider Number

120001

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/17/2023

Participating Start Date

4/1/2023

Participating Approval Date

1/30/2023

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

The Queen's Health Systems
Darlena Chadwick, Executive Vice President and Chief Operating Officer
(808) 691-3607

Primary Contact

The Queen's Health Systems
Eric King, Director, 340B Program
(808) 691-5323

Addresses

Street Address

91-2135 FORT WEAVER RD
3RD FLR
EWA BEACH, HI 96706

Billing Address

The Queen's Medical Center
1301 Punchbowl St
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

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH120001A	Child	DSH	THE QUEEN'S MEDICAL CENTER	Queen's Ambulatory Behavioral Health Services	The Queen's Medical Center	Honolulu	HI	Terminated
DSH120001AA	Child	DSH	THE QUEEN'S MEDICAL CENTER	Queens Pain & Spine POB3 - Pain and Spine Clinic_QMCP	550 S. BERETANIA STREET	Honolulu	HI	Active
DSH120001AB	Child	DSH	THE QUEEN'S MEDICAL CENTER	West Wound Center - Wound Care Center_QMCW	91-2127 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001AC	Child	DSH	THE QUEEN'S MEDICAL CENTER	Queen's Diabetes Edu Ctr - Queens Diabetes Edu Ctr_QMCP	1329 LUSITANIA ST	Honolulu	HI	Active
DSH120001AD	Child	DSH	THE QUEEN'S MEDICAL CENTER	West Mammography - Mammography_QMCW	91-2141 Fort Weaver Road	Ewa Beach	HI	Active
DSH120001AE	Child	DSH	THE QUEEN'S MEDICAL CENTER	West QDEC - Diabetes Mgmt_Educ Center_QMCW	91-2139 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001AF	Child	DSH	THE QUEEN'S MEDICAL CENTER	Observation - THE QUEENS MEDICAL CENTER - HPM 7_Acute Care_QMCP	347 N KUAKINI ST	HONOLULU	HI	Active
DSH120001AG	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Medical Center - West Oahu - Sleep Lab_QMCW	91-2127 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001AH	Child	DSH	THE QUEEN'S MEDICAL CENTER	Pulmonologist Clinic_QMCW - The Queen’s Medical Center - West Oahu Pulmonology Services	91-2127 Fort Weaver Rd	Ewa Beach	HI	Active
DSH120001AJ	Child	DSH	THE QUEEN'S MEDICAL CENTER	Comp Weight Mgmt Center_QMCP - The Queen's Comprehensive Weight Management Program	1380 Lusitana St.	Honolulu	HI	Active
DSH120001AK	Child	DSH	THE QUEEN'S MEDICAL CENTER	GI Svcs_QMCP - The Queen's Medical Center Gastroenterology Services	550 S. Beretania Street	Honolulu	HI	Active
DSH120001AL	Child	DSH	THE QUEEN'S MEDICAL CENTER	QUEEN'S MEDICAL CENTER - The Queen's Medical Center Cancer Center - Kuakini	321 N KUAKINI ST	HONOLULU	HI	Active
DSH120001AM	Child	DSH	THE QUEEN'S MEDICAL CENTER	QUEEN'S MEDICAL CENTER - The Queen's Medical Center - West Oahu Neuroscience	91-2135 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001AN	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEEN'S MEDICAL CENTER - The Queen's Medical Center - West Oahu ENT Services, 3rd Floor	91-2135 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001AP	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEEN'S MEDICAL CENTER - The Queen's Medical Center - West Oahu Urology Services, 3rd Floor	91-2135 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001AQ	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Cancer Center - Kuakini - Cancer Infusion	321 North Kuakini St.	Honolulu	HI	Active
DSH120001AR	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Heart Institute - ElectroPhysiology	550 S. BERETANIA STREET	Honolulu	HI	Active
DSH120001AS	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Medical Center - West Oahu - Pain Management	91-2135 Fort Weaver Rd.	Ewa Beach	HI	Active
DSH120001AT	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Medical Center - West Oahu - Outpatient Rehab	91-2135 Fort Weaver Rd.	Ewa Beach	HI	Active
DSH120001AU	Child	DSH	THE QUEEN'S MEDICAL CENTER	Behavioral Health - Day Treatment Services	1374 Nuuanu Ave.	Honolulu	HI	Active
DSH120001AV	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Medical Center - West Oahu - QMC - West Oahu MRI	91-2141 Fort Weaver Road	Ewa Beach	HI	Active
DSH120001AW	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Heart Institute - General Cardiology Hale Pawa'a	1401 S. Beretania St	Honolulu	HI	Active
DSH120001AX	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Medical Center - West Oahu - Infusion Treatment Center	91-2139 Fort Weaver Rd	Ewa Beach	HI	Active
DSH120001AY	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Medical Center - West Oahu - Orthopedic Services	91-2135 Fort Weaver Rd.	Ewa Beach	HI	Active
DSH120001AZ	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Medical Center - West Oahu - QMC-West Oahu Respiratory Care	91-2141 Fort Weaver Road	Ewa Beach	HI	Active
DSH120001C	Child	DSH	THE QUEEN'S MEDICAL CENTER	Queen's Ambulatory Behavioral Health Services	Kaheiheimalie Building	Honolulu	HI	Active
DSH120001CA	Child	DSH	THE QUEEN'S MEDICAL CENTER	West Physician Center - GI Services - Gastroenterology	91-2135 Fort Weaver Rd.	Ewa Beach	HI	Active
DSH120001CB	Child	DSH	THE QUEEN'S MEDICAL CENTER	West Radiation Therapy - Radiation Therapy	91-2135 Fort Weaver Rd.	Ewa Beach	HI	Active
DSH120001CC	Child	DSH	THE QUEEN'S MEDICAL CENTER	West Cancer Infusion Treatment Center - Cancer Infusion	91-2135 Fort Weaver Rd.	Ewa Beach	HI	Active
DSH120001CD	Child	DSH	THE QUEEN'S MEDICAL CENTER	Queen's Advanced Heart Failure - Cardiology	550 S. Beretania St.	Honolulu	HI	Active
DSH120001CE	Child	DSH	THE QUEEN'S MEDICAL CENTER	QHPP West Cardiology Clinic - Cardiology	91-2135 FORT WEAVER RD	Ewa Beach	HI	Active
DSH120001CF	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Medical Center - West Oahu - Sports Medicine	Clinical Service Center, 91-2135 Fort Weaver Road	Ewa Beach	HI	Active
DSH120001CG	Child	DSH	THE QUEEN'S MEDICAL CENTER	QMC-WO Pulmonary Lab - Pulmonary Lab	Sullivan Care Center, 91-2127 Fort Weaver Rd.	Ewa Beach	HI	Active
DSH120001CH	Child	DSH	THE QUEEN'S MEDICAL CENTER	QMC-West Oahu SDS Pre/Post - SD Pre_Post_QMCW	Clinical Service Center, Level 1, 91-2135 Fort Weaver Road	Ewa Beach	HI	Active
DSH120001CJ	Child	DSH	THE QUEEN'S MEDICAL CENTER	QMC-West Oahu Same Day Surgery Center - Same Day Surgery_QMCW	Clinical Service Center, Level 1, 91-2135 Fort Weaver Road	Ewa Beach	HI	Active
DSH120001D	Child	DSH	THE QUEEN'S MEDICAL CENTER	Queen's Colon Cancer Screening	550 S. Beretania Street	Honolulu	HI	Active
DSH120001E	Child	DSH	THE QUEEN'S MEDICAL CENTER	Queen's Liver Center	550 S BERETANIA ST	HONOLULU	HI	Active
DSH120001F	Child	DSH	THE QUEEN'S MEDICAL CENTER	Physician Office Building One (1) / Head and Neck Institute	1380 Lusitana Street	Honolulu	HI	Active
DSH120001G	Child	DSH	THE QUEEN'S MEDICAL CENTER	PHYSICIAN OFFICE BUILDING III / POB III Imaging	550 S BERETANIA ST	HONOLULU	HI	Active
DSH120001H	Child	DSH	THE QUEEN'S MEDICAL CENTER	Cardiology	98-1247 KAAHUMANU ST 208	AIEA	HI	Active
DSH120001J	Child	DSH	THE QUEEN'S MEDICAL CENTER	PHYSICIAN OFFICE BUILDING II / POB II Radiology	1329 LUSITANA ST	HONOLULU	HI	Active
DSH120001K	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER/TRANSPLANT CENTER / Transplantation	550 S. BERETANIA ST	HONOLULU	HI	Active
DSH120001L	Child	DSH	THE QUEEN'S MEDICAL CENTER	QUEEN'S IMAGING POB WEST	91-2139 FORT WEAVER RD STE. 108	EWA BEACH	HI	Active
DSH120001M	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER / West Ultrasound	91-2141 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001N	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER / West Main Operating Room	91-2141 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001P	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER / West Emergency Department	91-2141 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001Q	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER / West Cardiac Non-Invasive	91-2141 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001R	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER-WEST CANCER CENTER / Cancer Center	Clinical Service Center, 91-2135 Fort Weaver Road	EWA BEACH	HI	Active
DSH120001S	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER-WEST CT SCAN / CT Scan	91-2141 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001T	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER-WEST NUCLEAR MEDICINE / Nuclear Medicine	91-2141 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001U	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER -WEST X-RAY / X-Ray	91-2141 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001V	Child	DSH	THE QUEEN'S MEDICAL CENTER	THE QUEENS MEDICAL CENTER West PACU / PACU	91-2141 FORT WEAVER RD	EWA BEACH	HI	Active
DSH120001W	Child	DSH	THE QUEEN'S MEDICAL CENTER	The Queen's Medical Center - West Oahu - Observation	91-2141 Fort Weaver Road	Ewa Beach	HI	Active
DSH120001X	Child	DSH	THE QUEEN'S MEDICAL CENTER	Queen's Center for Sports Med - Sports_Med_QMCP	550 S. BERETANIA STREET	Honolulu	HI	Active
DSH120001Y	Child	DSH	THE QUEEN'S MEDICAL CENTER	West Endoscopy - Endoscopy_QMCW	91-2141 Fort Weaver Road	Ewa Beach	HI	Active
DSH120001Z	Child	DSH	THE QUEEN'S MEDICAL CENTER	West APEC (West Anethesia) - Anesthesia_QMCW	91-2141 Fort Weaver Road	Ewa Beach	HI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 5:13:23 PM	8/29/2024 6:38:10 PM	8/29/2024 6:38 PM
Details	Last Recertification Date	Update	Recertification		8/14/2023 5:13:23 PM	8/14/2023 5:13 PM
Details	State	Update		Approved	Active	4/1/2023 12:01 AM
Contacts	Authorizing Official	Update	Change Request	Chang, Jason Executive VP and COO The Queen's Health Systems 8086917988	Chadwick, Darlena Executive Vice President and Chief Operating Officer The Queen's Health Systems 8086913607	3/6/2023 7:03 AM
Contacts	Signed By	Insert	New Registration		Chang, Jason Executive VP and COO The Queen's Health Systems 8086917988	1/30/2023 1:27 PM
Details	340B ID	Update	New Registration		DSH120001AP	1/30/2023 1:27 PM
Details	Entity Name	Update	New Registration	THE QUEENS MEDICAL CENTER	THE QUEEN'S MEDICAL CENTER	1/30/2023 1:27 PM
Details	Entity Subname	Update	New Registration	THE QUEEN'S MEDICAL CENTER	THE QUEEN'S MEDICAL CENTER - The Queen's Medical Center - West Oahu Urology Services, 3rd Floor	1/30/2023 1:27 PM
Dates	Participating Approval Date	Update	New Registration		1/30/2023 1:27:45 PM	1/30/2023 1:27 PM
Details	State	Update	New Registration	Pending	Approved	1/30/2023 1:27 PM
Dates	Signed By Date	Update	New Registration		1/17/2023 8:47:42 PM	1/30/2023 1:27 PM
Dates	Start Date	Update	New Registration		4/1/2023 12:00:00 AM	1/30/2023 1:27 PM
Addresses	Main Address	Insert	New Registration		91-2135 FORT WEAVER RD 3RD FLR EWA BEACH, HI 96706	1/17/2023 6:33 PM
Addresses	Billing Address	Insert	New Registration		The Queen's Medical Center 1301 Punchbowl St Honolulu, HI 96813	1/17/2023 6:33 PM
Contacts	Authorizing Official	Insert	New Registration		Chang, Jason Executive VP and COO The Queen's Health Systems 8086917988	1/17/2023 6:33 PM
Contacts	Primary Contact	Insert	New Registration		King, Eric Director, 340B Program The Queen's Health Systems 8086915323	1/17/2023 6:33 PM
Details	Assistance Received From Date	Insert	New Registration			1/17/2023 6:33 PM
Details	Assistance Received To Date	Insert	New Registration			1/17/2023 6:33 PM
Details	Last Recertification Date	Insert	New Registration			1/17/2023 6:33 PM
Details	Grant Number	Insert	New Registration			1/17/2023 6:33 PM
Details	340B ID	Insert	New Registration			1/17/2023 6:33 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/17/2023 6:33 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/17/2023 6:33 PM
Details	Medicare Provider Number	Insert	New Registration		120001	1/17/2023 6:33 PM
Details	Entity Name	Insert	New Registration		THE QUEENS MEDICAL CENTER	1/17/2023 6:33 PM
Details	NOFO Number	Insert	New Registration			1/17/2023 6:33 PM
Details	Program Code	Insert	New Registration		DSH	1/17/2023 6:33 PM
Details	Entity Subname	Insert	New Registration		THE QUEEN'S MEDICAL CENTER	1/17/2023 6:33 PM
Dates	Participating Approval Date	Insert	New Registration			1/17/2023 6:33 PM
Details	State	Insert	New Registration		Pending	1/17/2023 6:33 PM
Dates	Registration Date	Insert	New Registration		1/17/2023 6:33:36 PM	1/17/2023 6:33 PM
Dates	Signed By Date	Insert	New Registration			1/17/2023 6:33 PM
Dates	Start Date	Insert	New Registration			1/17/2023 6:33 PM
Terminations	Termination Comments	Insert	New Registration			1/17/2023 6:33 PM
Terminations	Termination Date	Insert	New Registration			1/17/2023 6:33 PM
Terminations	Termination Effective Date	Insert	New Registration			1/17/2023 6:33 PM
Terminations	Termination Reason	Insert	New Registration			1/17/2023 6:33 PM