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DSH120028 QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL (Active)
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Main Details
Name
QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH120028
Medicare Provider Number
120028
Additional Details
Current Program Status
Active
Registration Date
9/8/2010
Participating Start Date
10/1/2011
Participating Approval Date
9/17/2010
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Queen's North Hawaii Community Hospital
Stephany Vaioleti, President
(808) 881-4402
Primary Contact
NORTH HAWAII COMMUNITY HOSPITAL
Travis Castle, PharmD
(808) 881-4467
Addresses
Street Address
67-1125 MAMALAHOA HWY
KAMUELA, HI 96743
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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09/29/11 participating 10/1/10 thru 6/30/11, not participating 7/1/11 thru 9/30/11, reinstatement approved 9/29/11
09/29/2011
9/17/2010- RECD. DOC. DEMONSTRATING ELIG. DSH PERCENTAGE
06/30/2011
09/29/10,participating 10/01/10 to 7/1/11,reinstated 10/1/11
09/08/2010
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