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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH120006 CASTLE MEDICAL CENTER dba ADVENTIST HEALTH CASTLE
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Covered Entity Details
Entity Name
CASTLE MEDICAL CENTER dba ADVENTIST HEALTH CASTLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH120006
Entity Address
640 ULUKAHIKI STREET
KAILUA, HI 96734
Medicare Provider Number
120006
Participating Start Date
4/1/2006
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: LONGS DRUGS # 04463
30 AULIKE ST SUITE #104
KAILUA, HI 96734
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Heidar Thordarson, VP Finance / CFO
(530) 751-4012
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2018
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