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CH096040 COMMUNITY CLINIC OF MAUI (Active)
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Main Details
Name
COMMUNITY CLINIC OF MAUI
Subdivision Name
Community Clinic of Maui
Type
HRSA-Funded Health Center
Site ID
BPS-H80-008908
340B ID
CH096040
Grant Number
H80CS00722
Additional Details
Current Program Status
Active
Registration Date
4/1/2004
Participating Start Date
4/1/2004
Participating Approval Date
3/8/2004
Last Recertification Date
2/25/2025
Contacts
Authorizing Official
Community Clinic of Maui, Inc.
John Vaz, Chief Executive Officer
(808) 872-1052
Primary Contact
Community Clinic of Maui, Inc
Monique van der Aa, Chief Financial Officer
(808) 872-4017
Addresses
Street Address
1881 Nani St
Wailuku, HI 96793-1811
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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9/28/09 ADDR CHANGE (WAS 48 LONO AVENUE)NEW SITE 04/01/2004
02/18/2010
April 2025
April 2025
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