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DSH120028A NORTH HAWAII COMMUNITY HOSPITAL (Terminated)
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Main Details
Name
NORTH HAWAII COMMUNITY HOSPITAL
Subdivision Name
NHCH GENERAL SURGERY CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH120028A
Medicare Provider Number
120028
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/28/2010
Participating Start Date
10/1/2011
Participating Approval Date
12/2/2010
Last Recertification Date
8/12/2015
Termination Date
Termination Reason
1/1/2016
Site closure
Contacts
Authorizing Official
North Hawaii Community Hospital
Cindy Kamikawa, President
(808) 881-4405
Primary Contact
Cherrie Carse, Director of Pharmacy
(808) 881-4467
Addresses
Street Address
67-1119 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
11/28/2010
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