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RWII96813 Life Foundation (Terminated)
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Main Details
Name
Life Foundation
Subdivision Name
Type
Ryan White Part B
340B ID
RWII96813
Grant Number
X07HA00050
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2014
Participating Start Date
10/1/2014
Participating Approval Date
7/17/2014
Last Recertification Date
1/26/2017
Time Period the Assistance was Received
Termination Date
Termination Reason
4/1/2018
Failure to recertify
Contacts
Authorizing Official
Life Foundation
Paul Groesbeck, Executive Director
(808) 853-3234
Primary Contact
Paul Groesbeck, Executive Director
(808) 853-3234
Addresses
Street Address
677 Ala Moana Blvd, Ste 226
Honolulu, HI 96813
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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