340B Drug Pricing Program Database
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DSH120005 HILO MEDICAL CENTER (Active)
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Main Details
Name
HILO MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH120005
Medicare Provider Number
120005
Additional Details
Current Program Status
Active
Registration Date
10/18/2007
Participating Start Date
4/1/2004
Participating Approval Date
10/18/2007
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Hilo Medical Center
Dan Brinkman, CEO
(808) 932-3101
Primary Contact
Hilo Medical Center
Allen Shih, Director of Pharmacy
(808) 932-3055
Addresses
Street Address
1190 WAIANUENUE AVENUE
HILO, HI 96720-2020
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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PART 4/1/02 - 12/31/03 AS DSH96720, INELIGIBLE 1/1/04 - 3/31/04
10/18/2007
May 2025
May 2025
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