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WALGREEN OF HAWAII, LLC
DSH120001 THE QUEEN'S MEDICAL CENTER
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Covered Entity Details
Entity Name
THE QUEEN'S MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH120001
Entity Address
1301 PUNCHBOWL STREET
HONOLULU, HI 96813-2499
Medicare Provider Number
120001
Participating Start Date
7/1/2002
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN OF HAWAII, LLC
Pharmacy Address
DBA: WALGREENS #12742
1613 NUUANU AVENUE
HONOLULU, HI 96817
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/8/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Jason Chang, Executive VP and COO
(808) 691-7988
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2018
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