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DSH120022U STRAUB CLINIC & HOSPITAL (Active)
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Main Details
Name
STRAUB CLINIC & HOSPITAL
Subdivision Name
STRAUB CLINIC & HOSPITAL - INTERNAL MED MILILANI
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH120022U
Medicare Provider Number
120022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/9/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/29/2025
Last Recertification Date
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
95-1249 MEHEULA PKWY
STE 187
MILILANI, HI 96789-1791
Billing Address
STRAUB CLINIC & HOSPITAL
55 MERCHANT ST, 24TH FLOOR
HONOLULU, HI 96813
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 7/1/2021, Termination 1/1/2024, Reinstatement 4/1/2025
01/28/2025
May 2025
May 2025
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