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WALGREEN OF MAUI, INC.
STD96793 Maui A.I.D.S. Foundation
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Covered Entity Details
Entity Name
Maui A.I.D.S. Foundation
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD96793
Entity Address
1935 Main St.
Suite 101
Wailuku, HI 96793
Grant Number
NH25PS005136
Participating Start Date
10/1/2018
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN OF MAUI, INC.
Pharmacy Address
DBA: WALGREENS #11192
342 KEAWE ST., BLDG D
LAHAINA, HI 96761
Pharmacy Comments
Contract Details
Approval Date
1/7/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark S. Anderson, Executive Director
(808) 242-4900
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/7/2019
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