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SCH120014-00 WILCOX MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
WILCOX MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH120014-00
Medicare Provider Number
120014
Additional Details
Current Program Status
Terminated
Registration Date
9/20/2010
Participating Start Date
9/21/2010
Participating Approval Date
9/21/2010
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
10/1/2022
Change of covered entity type
Contacts
Authorizing Official
Wilcox Memorial Hospital
JEN CHAHANOVICH, CEO
(808) 245-1100 Ext: 1103
Primary Contact
WILCOX MEMORIAL HOSPITAL
KENT KIKUCHI, DIRECTOR OF ANCILLARY SERVICES
(808) 245-1100 Ext: 1206
Addresses
Street Address
3-3420 KUHIO HWY
LIHUE, HI 96766
Billing Address
WILCOX MEMORIAL HOSPITAL
55 MERCHANT ST, 24TH FLOOR
HONOLULU, HI 96813
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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