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QUEEN'S POB WEST PHARMACY
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
QUEEN'S POB WEST PHARMACY
Pharmacy Address
91-2139 FORT WEAVER RD STE 106
EWA BEACH, HI 96706-3608
Pharmacy Comments
Contract Details
Approval Date
7/9/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Chang, Executive VP and COO
(808) 691-7988
Contract Pharmacy Representative
Queen's Development Corporation
Bernadette Merlino, President
(808) 691-4342
Signed By Date
7/9/2019
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