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WAL-MART PHARMACY 10-5274
CH092060 WAIKIKI HEALTH
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Covered Entity Details
Entity Name
WAIKIKI HEALTH
Subdivision Name
Waikiki Health Ohua
Type
HRSA-Funded Health Center
340B ID
CH092060
Entity Address
277 Ohua Ave
Honolulu, HI 96815-3643
Grant Number
H80CS00053
Participating Start Date
4/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5274
Pharmacy Address
1131 KUALA ST.
PEARL CITY, HI 96782
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Phyllis Dendle, CEO
(808) 537-8443
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2019
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