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WALGREEN OF HAWAII, LLC.
NH96793 Hui No Ke Ola Pono
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Covered Entity Details
Entity Name
Hui No Ke Ola Pono
Subdivision Name
Type
Native Hawaiian Health Care Program
340B ID
NH96793
Entity Address
95 Mahalani Street, Room 21
Wailuku, HI 96793
Grant Number
H1CCS00014
Participating Start Date
7/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN OF HAWAII, LLC.
Pharmacy Address
DBA: WALGREENS #12763
2180 MAIN STREET, STE 102
WAILUKU, HI 96793
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joseph Gonsalves, EXECUTIVE DIRECTOR
(808) 244-4647
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2018
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