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WAL-MART PHARMACY 10-2473
HV00642A Hawaii Island HIV/AIDS Foundation
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Covered Entity Details
Entity Name
Hawaii Island HIV/AIDS Foundation
Subdivision Name
Hilo
Type
Ryan White Part C
340B ID
HV00642A
Entity Address
101 Aupuni St.
Suite PH 1014-C
Hilo, HI 96720
Grant Number
6 H76HA00642-24-02
Participating Start Date
9/15/2020
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2473
Pharmacy Address
325 MAKAALA STREET
HILO, HI 96720
Pharmacy Comments
Contract Details
Approval Date
9/15/2020
Contract Begin Date
9/15/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Peter T Silva, Executive Director
(808) 982-8800
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
9/14/2020
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