340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PHARMACARE NO. 5
RRC120026-00 PALI MOMI MEDICAL CENTER
Print
Covered Entity Details
Entity Name
PALI MOMI MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC120026-00
Entity Address
98-1079 MOANALUA ROAD
AIEA, HI 96701
Medicare Provider Number
120026
Participating Start Date
11/9/2020
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
PHARMACARE NO. 5
Pharmacy Address
98-1079 MOANALUA RD, MOB STE 150
AIEA, HI 96701-4713
Pharmacy Comments
Contract Details
Approval Date
11/9/2020
Contract Begin Date
11/9/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/21/2022
Ownership change
Contacts
Covered Entity Signing Official
MARTHA SMITH, Executive Vice President, Oahu Operations
(808) 522-2520
Contract Pharmacy Representative
Pharmacare Hawaii
Byron N Yoshino, President and CEO
(808) 840-5656
Signed By Date
10/14/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session