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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH120001P THE QUEEN'S MEDICAL CENTER
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Covered Entity Details
Entity Name
THE QUEEN'S MEDICAL CENTER
Subdivision Name
THE QUEENS MEDICAL CENTER / West Emergency Department
Type
Disproportionate Share Hospital
340B ID
DSH120001P
Entity Address
91-2141 FORT WEAVER RD
THE QUEENS MEDICAL CENTER - WEST OAHU
EWA BEACH, HI 96706-1993
Medicare Provider Number
120001
Outpatient Facility Provider Number
Participating Start Date
4/1/2017
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: LONGS DRUGS # 09259
94-060 FARRINGTON HWY #6
WAIPAHU, HI 96797
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Chang, Executive VP and COO
(808) 691-7988
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2019
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