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RRC120022-00 STRAUB CLINIC & HOSPITAL (Terminated)
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Main Details
Name
STRAUB CLINIC & HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC120022-00
Medicare Provider Number
120022
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/25/2023
Last Recertification Date
8/21/2024
Termination Date
Termination Reason
4/1/2025
Change of covered entity type
Contacts
Authorizing Official
Hawaii Pacific Health
David E Stumbaugh, VP, Supply Chain Management and Pharmacy
(808) 522-6946
Primary Contact
Hawaii Pacific Health
Shiela P Magday, 340B Program Manager
(808) 774-1342
Addresses
Street Address
888 S. KING STREET
HONOLULU, HI 96813
Billing Address
Straub Clinic and Hospital
55 Merchant St, 24th floor
Honolulu, HI 96813
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 11/03/2020; Terminated 7/1/2021; Reinstated 1/1/2024
10/25/2023
May 2025
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