Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CH096040 COMMUNITY CLINIC OF MAUI

Covered Entity Details

Entity Name

COMMUNITY CLINIC OF MAUI

Subdivision Name

Community Clinic of Maui

Type

HRSA-Funded Health Center

340B ID

CH096040

Entity Address

1881 Nani St
Wailuku, HI 96793-1811

Grant Number

H80CS00722

Participating Start Date

4/1/2004

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: LONGS DRUGS # 09663
70 E KAAHUMANU AVE
KAHULUI, HI 96732

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

BJ OTT, CHIEF EXECUTIVE OFFICER
(808) 872-4018

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/15/2020

340B Drug Pricing Program Database