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WALGREEN OF HAWAII LLC
FP967204 BAY CLINIC INC
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Covered Entity Details
Entity Name
BAY CLINIC INC
Subdivision Name
Hilo Women's Health Center
Type
Family Planning (Title X only)
340B ID
FP967204
Entity Address
73 Puuhonu Place, Ste. 204
Hilo, HI 96720
Grant Number
FPHPA090326
Participating Start Date
7/1/2011
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
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Youlsau Bells, Interim Chief Executive Officer
(808) 961-4078
Contract Pharmacy Representative
Walgreens
Ted Kountouris, Regional Manager
(626) 806-1853
Signed By Date
7/11/2019
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