340B Drug Pricing Program Database
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RRC120026-02 PALI MOMI MEDICAL CENTER (Active)
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Main Details
Name
PALI MOMI MEDICAL CENTER
Subdivision Name
PALI MOMI MEDICAL CENTER - Cancer Center
Type
Rural Referral Center
Rural
No
340B ID
RRC120026-02
Medicare Provider Number
120026
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2020
Participating Start Date
11/9/2020
Participating Approval Date
11/9/2020
Last Recertification Date
8/21/2024
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
98-1005 MOANALUA RD
STE 4000
AIEA, HI 96701
Billing Address
Pali Momi Medical Center
55 Merchant St, 24th Floor
Honolulu, HI 96813
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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