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DSH120014 WILCOX MEMORIAL HOSPTIAL (Active)
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Main Details
Name
WILCOX MEMORIAL HOSPTIAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH120014
Medicare Provider Number
120014
Additional Details
Current Program Status
Active
Registration Date
7/1/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/6/2022
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Wilcox Memorial Hospital
JEN CHAHANOVICH, CEO
(808) 245-1100 Ext: 1103
Primary Contact
Hawaii Pacific Health
Shiela P Magday, 340B Program Manager
(808) 774-1342
Addresses
Street Address
3-3420 KUHIO HIGHWAY
LIHUE, HI 96766
Billing Address
Wilcox Memorial Hospital
55 Merchant Street
24th Floor
Honolulu, HI 96813
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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