340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH120026 PALI MOMI MEDICAL CENTER (Terminated)
Print
Main Details
Name
PALI MOMI MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH120026
Medicare Provider Number
120026
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/8/2014
Last Recertification Date
11/9/2017
Termination Date
Termination Reason
1/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
Pali Momi Medical Center
Art Gladstone, Chief Executive Officer
(808) 485-4434
Primary Contact
pali momi medical center
Carlotta M. Meier-Irving, Pharmacy Manager
(808) 485-3865
Addresses
Street Address
98-1079 MOANALUA ROAD
AIEA, HI 96701
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session