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LIHUE PHARMACY INC
RWII968131 Community Health Outreach Work to Prevent AIDS
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Covered Entity Details
Entity Name
Community Health Outreach Work to Prevent AIDS
Subdivision Name
Type
Ryan White Part B
340B ID
RWII968131
Entity Address
677 Ala Moana #226
Hawaii
Honolulu, HI 96813
Grant Number
X07HA00050
Participating Start Date
1/1/2018
Last Recertification Date
1/31/2024
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
LIHUE PHARMACY INC
Pharmacy Address
LIHUE PHARMACY INC
4491 KOLOPA ST # A
LIHUE, HI 96766-2021
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
10/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Heather Lusk, Executive Director
(808) 853-3292
Contract Pharmacy Representative
Lihue Pharmacy
Kevin Glick, Director
(808) 246-9100
Signed By Date
7/3/2019
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