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WALGREEN OF HAWAII LLC
FP96749 BAY CLINIC INC
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Covered Entity Details
Entity Name
BAY CLINIC INC
Subdivision Name
Kea'au Family Health and Dental Center
Type
Family Planning (Title X only)
340B ID
FP96749
Entity Address
16-192 Pili Mua Street
Kea'au, HI 96749
Grant Number
FPHPA090326
Participating Start Date
4/1/2007
Last Recertification Date
5/9/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN OF HAWAII LLC
Pharmacy Address
DBA WALGREENS #13836
301 E. MAKAALA ST.
HILO, HI 96720-5146
Pharmacy Comments
Contract Details
Approval Date
7/3/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/9/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Youlsau Bells, Interim Chief Executive Officer
(808) 961-4078
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/3/2019
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