340B Drug Pricing Program Database
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DSH120002A MAUI HEALTH SYSTEM, A KAISER FOUNDATION HOSPITALS, LLC, dba Maui Memorial Medical Center (Terminated)
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Main Details
Name
MAUI HEALTH SYSTEM, A KAISER FOUNDATION HOSPITALS, LLC, dba Maui Memorial Medical Center
Subdivision Name
MAUI MEMORIAL MEDICAL CENTER OUTPATIENT CLINIC - MAUI MEMORIAL MEDICAL CENTER OUTPATIENT CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH120002A
Medicare Provider Number
120002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/22/2019
Last Recertification Date
8/22/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Maui Health System, A Kaiser Foundation Hospitals LLC
Joyce Tamori, Chief Financial Officer
(808) 243-3095
Primary Contact
Maui Health System, A Kaiser Foundation Hospitals, LLC
Daniel Navas, Director of Pharmacy
(808) 242-2120
Addresses
Street Address
85 MAUI LANI PARKWAY
WAILUKU, HI 96793
Billing Address
MAUI MEMORIAL MEDICAL CENTER
221 MAHALANI ST
WAILUKU, HI 96793
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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