340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
LONGS DRUG STORES CALIFORNIA, L.L.C.
SCH120014-00 WILCOX MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
WILCOX MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH120014-00
Entity Address
3-3420 KUHIO HWY
LIHUE, HI 96766
Medicare Provider Number
120014
Participating Start Date
9/21/2010
Last Recertification Date
9/10/2021
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA LONGS DRUGS #10474
2829 ALA KALANIKAUMAUKA STREET, SUITE M-
KOLOA, HI 96756
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JEN CHAHANOVICH, CEO
(808) 245-1100 Ext: 1103
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session