Contract Pharmacy Details

WALGREEN OF HAWAII LLC
FP967202 BAY CLINIC INC

Covered Entity Details

Entity Name

BAY CLINIC INC

Subdivision Name

Hilo Family Health Center

Type

Family Planning (Title X only)

340B ID

FP967202

Entity Address

1178 Kino'ole Street
Hilo, HI 96720

Grant Number

FPHPA090326

Participating Start Date

1/1/1998

Last Recertification Date

5/9/2022

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN OF HAWAII LLC

Pharmacy Address

DBA: WALGREENS #16272 SPECIALTY PHARMACY
615 PIIKOI ST STE 105
HONOLULU, HI 96814

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

340B Drug Pricing Program Database