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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH120028 QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH120028
Entity Address
67-1125 MAMALAHOA HWY
KAMUELA, HI 96743
Medicare Provider Number
120028
Participating Start Date
10/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: LONGS DRUGS # 02406
65-1271 KAWAIHAE RD
KAMUELA, HI 96743
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cindy Kamikawa, President
(808) 881-4405
Contract Pharmacy Representative
WellPartner, A CVS Health Company
Derek Sterns, National Sales Representative
(503) 317-9840
Signed By Date
10/15/2018
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