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DSH120022Z STRAUB CLINIC & HOSPITAL (Terminated)
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Main Details
Name
STRAUB CLINIC & HOSPITAL
Subdivision Name
STRAUB MEDICAL CENTER - ONCOLOGY PEARLRIDGE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH120022Z
Medicare Provider Number
120022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/27/2022
Last Recertification Date
9/2/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
Hawaii Pacific Health
David E Stumbaugh, VP, Supply Chain Management and Pharmacy
(808) 522-6946
Primary Contact
Hawaii Pacific Health
Dawn Tsuha-Scarlett, Director, 340B Program and Pharmacy Regulatory Compliance
(808) 404-8382
Addresses
Street Address
98-151 PALI MOMI ST
STE 142
AIEA, HI 96701-4333
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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