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DSH120002 MAUI HEALTH SYSTEM, A KAISER FOUNDATION HOSPITALS, LLC, dba Maui Memorial Medical Center (Active)
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Main Details
Name
MAUI HEALTH SYSTEM, A KAISER FOUNDATION HOSPITALS, LLC, dba Maui Memorial Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH120002
Medicare Provider Number
120002
Additional Details
Current Program Status
Active
Registration Date
12/15/2008
Participating Start Date
1/1/2009
Participating Approval Date
12/15/2008
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
Maui Health System, A Kaiser Foundation Hospitals, LLC
Wade Ebersole, COO
(808) 264-3312
Primary Contact
Maui Health System, A Kaiser Foundation Hospitals, LLC
Daniel Navas, Director of Pharmacy
(808) 242-2120
Addresses
Street Address
221 MAHALANI ST
WAILUKU, HI 96793
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/08- DOC RECD TO CONFIRM ELIGIBLE DSH ADJ%; PREV PART AS DSH96793 FROM 1/1/2005 - 6/30/2007, INELIG 7/1/2007 TO 12/31/2008
12/15/2008
June 2025
June 2025
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