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SAFEWAY INC
PED123300-00 KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN
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Covered Entity Details
Entity Name
KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN
Subdivision Name
Type
Children's Hospital
340B ID
PED123300-00
Entity Address
1319 PUNAHOU STREET
HONOLULU, HI 96826
Medicare Provider Number
123300
Participating Start Date
8/6/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1087
200 HAMAKUA DRIVE
KAILUA, HI 96734
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/4/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARTHA SMITH, Executive Vice President, Oahu Operations
(808) 522-2520
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
1/11/2019
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